Surgical instrument

ABSTRACT

In one embodiment, a surgical instrument comprises an articulable waveguide. The articulable waveguide may be configured to transmit ultrasonic energy therealong. The articulable waveguide comprises a proximal drive section, an end effector and a first flexible. The proximal drive section is configured to couple to an ultrasonic transducer. The end effector is located at a distal portion of the articulable waveguide. The first flexible section comprises a flex bias and be positioned between the proximal drive section and the end effector. The surgical instrument further comprises a first tine extending longitudinally relative to the articulable waveguide.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application claiming priority under 35U.S.C. §121 to U.S. patent application Ser. No. 13/657,553, entitledFLEXIBLE HARMONIC WAVEGUIDES/BLADES FOR SURGICAL INSTRUMENTS, filed Oct.22, 2012, now U.S. Patent Application Publication No. US 2014/0114334,the disclosure of which is hereby incorporated by reference in itsentirety.

The present application is related to the following, previously-filedU.S. patent application, which are incorporated herein by reference inits entirety:

-   U.S. application Ser. No. 13/657,315, now U.S. Patent Application    Publication No. 2014/0114327, entitled “Surgeon Feedback Sensing and    Display Methods”.-   U.S. application Ser. No. 13/539,096, now U.S. Patent Application    Publication No. 2014/0005682, entitled “Haptic Feedback Devices for    Surgical Robot”;-   U.S. application Ser. No. 13/539,110, now U.S. Patent Application    Publication No. 2014/0005654, entitled “Lockout Mechanism for Use    with Robotic Electrosurgical Device”;-   U.S. application Ser. No. 13/539,117, now U.S. Patent Application    Publication No. 2014/0005667, entitled “Closed Feedback Control for    Electrosurgical Device”;-   U.S. application Ser. No. 13/538,588, now U.S. Patent Application    Publication No. 2014/0005701, entitled “Surgical Instruments with    Articulating Shafts”;-   U.S. application Ser. No. 13/538,601, now U.S. Patent Application    Publication No. 2014/0005702, entitled “Ultrasonic Surgical    Instruments with Distally Positioned Transducers”;-   U.S. application Ser. No. 13/538,700, now U.S. Patent Application    Publication No. 2014/0005703, entitled “Surgical Instruments with    Articulating Shafts”;-   U.S. application Ser. No. 13/538,711, now U.S. Patent Application    Publication No. 2014/0005704, entitled “Ultrasonic Surgical    Instruments with Distally Positioned Jaw Assemblies”;-   U.S. application Ser. No. 13/538,720, now U.S. Patent Application    Publication No. 2014/0005705, entitled “Surgical Instruments with    Articulating Shafts”;-   U.S. application Ser. No. 13/538,733, now U.S. Patent Application    Publication No. 2014/0005681, entitled “Ultrasonic Surgical    Instruments with Control Mechanisms”; and-   U.S. application Ser. No. 13/539,122, now U.S. Patent Application    Publication No. 2014/0005668, entitled “Surgical Instruments with    Fluid Management System”.

BACKGROUND

Various embodiments are directed to surgical devices including variousarticulable harmonic waveguides.

Ultrasonic surgical devices, such as ultrasonic scalpels, are used inmany applications in surgical procedures by virtue of their uniqueperformance characteristics. Depending upon specific deviceconfigurations and operational parameters, ultrasonic surgical devicescan provide substantially simultaneous transection of tissue andhomeostasis by coagulation, desirably minimizing patient trauma. Anultrasonic surgical device comprises a proximally-positioned ultrasonictransducer and an instrument coupled to the ultrasonic transducer havinga distally-mounted end effector comprising an ultrasonic blade to cutand seal tissue. The end effector is typically coupled either to ahandle and/or a robotic surgical implement via a shaft. The blade isacoustically coupled to the transducer via a waveguide extending throughthe shaft. Ultrasonic surgical devices of this nature can be configuredfor open surgical use, laparoscopic, or endoscopic surgical proceduresincluding robotic-assisted procedures.

Ultrasonic energy cuts and coagulates tissue using temperatures lowerthan those used in electrosurgical procedures. Vibrating at highfrequencies (e.g., 55,500 times per second), the ultrasonic bladedenatures protein in the tissue to form a sticky coagulum. Pressureexerted on tissue by the blade surface collapses blood vessels andallows the coagulum to form a hemostatic seal. A surgeon can control thecutting speed and coagulation by the force applied to the tissue by theend effector, the time over which the force is applied and the selectedexcursion level of the end effector.

Also used in many surgical applications are electrosurgical devices.Electrosurgical devices apply electrical energy to tissue in order totreat tissue. An electrosurgical device may comprise an instrumenthaving a distally-mounted end effector comprising one or moreelectrodes. The end effector can be positioned against tissue such thatelectrical current is introduced into the tissue. Electrosurgicaldevices can be configured for bipolar or monopolar operation. Duringbipolar operation, current is introduced into and returned from thetissue by active and return electrodes, respectively, of the endeffector. During monopolar operation, current is introduced into thetissue by an active electrode of the end effector and returned through areturn electrode (e.g., a grounding pad) separately located on apatient's body. Heat generated by the current flow through the tissuemay form haemostatic seals within the tissue and/or between tissues andthus may be particularly useful for sealing blood vessels, for example.The end effector of an electrosurgical device sometimes also comprises acutting member that is movable relative to the tissue and the electrodesto transect the tissue.

Electrical energy applied by an electrosurgical device can betransmitted to the instrument by a generator. The electrical energy maybe in the form of radio frequency (“RF”) energy. RF energy is a form ofelectrical energy that may be in the frequency range of 300 kHz to 1MHz. During its operation, an electrosurgical device can transmit lowfrequency RF energy through tissue, which causes ionic agitation, orfriction, in effect resistive heating, thereby increasing thetemperature of the tissue. Because a sharp boundary may be createdbetween the affected tissue and the surrounding tissue, surgeons canoperate with a high level of precision and control, without sacrificingun-targeted adjacent tissue. The low operating temperatures of RF energymay be useful for removing, shrinking, or sculpting soft tissue whilesimultaneously sealing blood vessels. RF energy may work particularlywell on connective tissue, which is primarily comprised of collagen andshrinks when contacted by heat.

In many cases it is desirable to utilize an ultrasonic blade that iscurved or otherwise asymmetric. Currently, asymmetric blades aremachined into a curved state. It would be desirable to have anarticulable harmonic blade that may be operated in a straightconfiguration or in a curved configuration and which may be movedbetween the straight and curved configurations.

SUMMARY

Various embodiments described herein are directed to surgicalinstruments comprising an articulable waveguide. In one embodiment, asurgical instrument comprises an articulable waveguide. The articulablewaveguide may be configured to transmit ultrasonic energy therealong.The articulable waveguide comprises a proximal drive section, an endeffector and a first flexible. The proximal drive section is configuredto couple to an ultrasonic transducer. The end effector is located at adistal portion of the articulable waveguide. The first flexible sectioncomprises a flex bias and be positioned between the proximal drivesection and the end effector. The surgical instrument further comprisesa first tine extending longitudinally relative to the articulablewaveguide.

DRAWINGS

The features of the various embodiments are set forth with particularityin the appended claims. The various embodiments, however, both as toorganization and methods of operation, together with advantages thereof,may best be understood by reference to the following description, takenin conjunction with the accompanying drawings as follows:

FIG. 1 illustrates one embodiment of a surgical system including asurgical instrument and an ultrasonic generator.

FIG. 2 illustrates one embodiment of the surgical instrument shown inFIG. 1.

FIG. 3 illustrates one embodiment of an ultrasonic end effector.

FIG. 4 illustrates another embodiment of an ultrasonic end effector.

FIG. 5 illustrates an exploded view of one embodiment of the surgicalinstrument shown in FIG. 1.

FIG. 6 illustrates a cut-away view of one embodiment of the surgicalinstrument shown in FIG. 1.

FIG. 7 illustrates various internal components of one example embodimentof the surgical instrument shown in FIG. 1

FIG. 8 illustrates a top view of one embodiment of a surgical systemincluding a surgical instrument and an ultrasonic generator.

FIG. 9 illustrates one embodiment of a rotation assembly included in oneexample embodiment of the surgical instrument of FIG. 1.

FIG. 10 illustrates one embodiment of a surgical system including asurgical instrument having a single element end effector.

FIG. 11 is a perspective view of one embodiment of an electrical energysurgical instrument.

FIG. 12 is a side view of a handle of one embodiment of the surgicalinstrument of FIG. 11 with a half of a handle body removed to illustratesome of the components therein.

FIG. 13 illustrates a perspective view of one embodiment of the endeffector of the surgical instrument of FIG. 11 with the jaws open andthe distal end of an axially movable member in a retracted position.

FIG. 14 illustrates a perspective view of one embodiment of the endeffector of the surgical instrument of FIG. 11 with the jaws closed andthe distal end of an axially movable member in a partially advancedposition.

FIG. 15 illustrates a perspective view of one embodiment of the axiallymoveable member of the surgical instrument of FIG. 11.

FIG. 16 illustrates a section view of one embodiment of the end effectorof the surgical instrument of FIG. 11.

FIG. 17 illustrates a section a perspective view of one embodiment of acordless electrical energy surgical instrument.

FIG. 18A illustrates a side view of a handle of one embodiment of thesurgical instrument of FIG. 17 with a half handle body removed toillustrate various components therein.

FIG. 18B illustrates an RF drive and control circuit, according to oneembodiment.

FIG. 18C illustrates the main components of the controller, according toone embodiment.

FIG. 19 illustrates a block diagram of one embodiment of a roboticsurgical system.

FIG. 20 illustrates one embodiment of a robotic arm cart.

FIG. 21 illustrates one embodiment of the robotic manipulator of therobotic arm cart of FIG. 20.

FIG. 22 illustrates one embodiment of a robotic arm cart having analternative set-up joint structure.

FIG. 23 illustrates one embodiment of a controller that may be used inconjunction with a robotic arm cart, such as the robotic arm carts ofFIGS. 19-22.

FIG. 24 illustrates one embodiment of an ultrasonic surgical instrumentadapted for use with a robotic system.

FIG. 25 illustrates one embodiment of an electrosurgical instrumentadapted for use with a robotic system.

FIG. 26 illustrates one embodiment of an instrument drive assembly thatmay be coupled to surgical manipulators to receive and control thesurgical instrument shown in FIG. 24.

FIG. 27 illustrates another view of the instrument drive assemblyembodiment of FIG. 26 including the surgical instrument of FIG. 24.

FIG. 28 illustrates another view of the instrument drive assemblyembodiment of FIG. 26 including the electrosurgical instrument of FIG.25.

FIGS. 29-31 illustrate additional views of the adapter portion of theinstrument drive assembly embodiment of FIG. 26.

FIGS. 32-34 illustrate one embodiment of the instrument mounting portionof FIGS. 24-25 showing components for translating motion of the drivenelements into motion of the surgical instrument.

FIGS. 35-37 illustrate an alternate embodiment of the instrumentmounting portion of FIGS. 24-25 showing an alternate example mechanismfor translating rotation of the driven elements into rotational motionabout the axis of the shaft and an alternate example mechanism forgenerating reciprocating translation of one or more members along theaxis of the shaft 538.

FIGS. 38-42 illustrate an alternate embodiment of the instrumentmounting portion FIGS. 24-25 showing another alternate example mechanismfor translating rotation of the driven elements into rotational motionabout the axis of the shaft.

FIGS. 43-46A illustrate an alternate embodiment of the instrumentmounting portion showing an alternate example mechanism for differentialtranslation of members along the axis of the shaft (e.g., forarticulation).

FIGS. 46B-46C illustrate one embodiment of an instrument mountingportion comprising internal power and energy sources.

FIG. 47 illustrates one embodiment of an articulable harmonic waveguide.

FIGS. 48A-48C illustrate one embodiment of an articulable harmonicwaveguide comprising a ribbon flexible waveguide.

FIG. 49 illustrates one embodiment of an articulable harmonic waveguidecomprising a hollow end effector.

FIG. 50 illustrates one embodiment of an articulable harmonic waveguidecomprising a circular flexible waveguide and a solid end effector.

FIG. 51 illustrates one embodiment of an articulable harmonic waveguidecomprising a ribbon flexible waveguide with one or more slots formedtherein.

FIGS. 52A-52B illustrate on embodiment of a articulable harmonicwaveguide comprising a first drive section, a first flexible waveguide,a second drive section, and a second flexible waveguide.

FIGS. 53A-53B illustrate one embodiment of an articulable harmonicwaveguide comprising a wave amplification section.

FIG. 54 illustrates one embodiment of the articulable harmonic waveguideof FIGS. 53A-53B in a flexed position.

FIGS. 55A-55B illustrate one embodiment of an articulation actuator.

FIG. 56 illustrates one embodiment of a two-cable articulation actuator.

FIG. 57 illustrates one embodiment of an ultrasonic surgical instrumentcomprising an articulable harmonic waveguide and a total curvaturelimiter.

FIG. 58 illustrates one embodiment of an ultrasonic surgical instrumentcomprising an articulable harmonic waveguide and a two-stage electricaltotal curvature limiter.

FIG. 59 illustrates one embodiment of an articulable harmonic waveguidecomprising a total curvature limiter.

FIG. 60 illustrates one embodiment of an ultrasonic surgical instrumentcomprising an articulable harmonic waveguide and a total curvaturelimiter comprising a viewing window.

FIG. 61 illustrates one embodiment of an articulable harmonic waveguidecomprising a flexible waveguide centered about an anti-node.

FIG. 62 illustrates one embodiment of a robotic ultrasonic surgicalinstrument comprising an articulable harmonic waveguide.

FIG. 63 illustrates one embodiment of a bayonet forceps surgicalinstrument.

FIGS. 64A-64B illustrate one embodiment of a flexible ultrasonic shearsinstrument comprising an articulable harmonic waveguide.

FIGS. 65A-65B illustrate one embodiment of a flexible ultrasonic shearsinstrument.

FIGS. 66A-66B illustrate one embodiment of a flexible ultrasonic shearsinstrument comprising a flexible sheath with a plurality of flexfeatures.

DESCRIPTION

Various embodiments are directed to an ultrasonic surgical instrumentincluding an articulable harmonic waveguide. The ultrasonic blade maycomprise a proximally positioned straight drive section extending alonga longitudinal axis and a distally positioned flexible waveguide coupledto the straight drive section and flexible at an angle from thelongitudinal axis. The flexible waveguide may be articulated to define aradius of curvature and may subtend a first angle. The point of tangencybetween the flexible waveguide and the drive section may be at a node,an anti-node, or between a node and antinode of the articulable harmonicwaveguide. The articulable harmonic waveguide may be balanced, forexample, based on properties of the flexible waveguide. A balancedarticulable harmonic waveguide may have vibrational modes that arepurely and/or substantially longitudinal (e.g., in the direction of thelongitudinal axis). To achieve balance, the articulable harmonicwaveguide may be constructed, as described above, such that a nodeand/or anti-node occurs at the point of tangency when the articulableharmonic waveguide is driven at a resonant frequency.

Some embodiments are directed to a surgical instrument comprising an endeffector and articulable harmonic waveguide extending along alongitudinal axis. The articulable harmonic waveguide is acousticallycoupled to the end effector and extends proximally from the end effectorthrough the shaft. The articulable harmonic waveguide may comprise aflexible waveguide portion positioned on the longitudinal axis. Thewaveguide may also comprise first and second flanges positioned at nodesof the waveguide. The first flange may be positioned distally from theflexible waveguide portion, with the second flange positioned proximallyfrom the flexible waveguide portion. A first control member may becoupled to the first flange and extend proximally through the secondflange and shaft. Proximal translation of the first control member maypull the first flange proximally, causing the shaft and waveguide topivot away from the longitudinal axis towards the first control member.

Reference will now be made in detail to several embodiments, includingembodiments showing example implementations of manual and roboticsurgical instruments with end effectors comprising ultrasonic and/orelectrosurgical elements. Wherever practicable similar or like referencenumbers may be used in the figures and may indicate similar or likefunctionality. The figures depict example embodiments of the disclosedsurgical instruments and/or methods of use for purposes of illustrationonly. One skilled in the art will readily recognize from the followingdescription that alternative example embodiments of the structures andmethods illustrated herein may be employed without departing from theprinciples described herein.

FIG. 1 is a right side view of one embodiment of an ultrasonic surgicalinstrument 10. In the illustrated embodiment, the ultrasonic surgicalinstrument 10 may be employed in various surgical procedures includingendoscopic or traditional open surgical procedures. In one exampleembodiment, the ultrasonic surgical instrument 10 comprises a handleassembly 12, an elongated shaft assembly 14, and an ultrasonictransducer 16. The handle assembly 12 comprises a trigger assembly 24, adistal rotation assembly 13, and a switch assembly 28. The elongatedshaft assembly 14 comprises an end effector assembly 26, which compriseselements to dissect tissue or mutually grasp, cut, and coagulate vesselsand/or tissue, and actuating elements to actuate the end effectorassembly 26. The handle assembly 12 is adapted to receive the ultrasonictransducer 16 at the proximal end. The ultrasonic transducer 16 ismechanically engaged to the elongated shaft assembly 14 and portions ofthe end effector assembly 26. The ultrasonic transducer 16 iselectrically coupled to a generator 20 via a cable 22. Although themajority of the drawings depict a multiple end effector assembly 26 foruse in connection with laparoscopic surgical procedures, the ultrasonicsurgical instrument 10 may be employed in more traditional open surgicalprocedures and in other embodiments, may be configured for use inendoscopic procedures. For the purposes herein, the ultrasonic surgicalinstrument 10 is described in terms of an endoscopic instrument;however, it is contemplated that an open and/or laparoscopic version ofthe ultrasonic surgical instrument 10 also may include the same orsimilar operating components and features as described herein.

In various embodiments, the generator 20 comprises several functionalelements, such as modules and/or blocks. Different functional elementsor modules may be configured for driving different kinds of surgicaldevices. For example, an ultrasonic generator module 21 may drive anultrasonic device, such as the ultrasonic surgical instrument 10. Insome example embodiments, the generator 20 also comprises anelectrosurgery/RF generator module 23 for driving an electrosurgicaldevice (or an electrosurgical embodiment of the ultrasonic surgicalinstrument 10). In various embodiments, the generator 20 may be formedintegrally within the handle assembly 12. In such implementations, abattery would be co-located within the handle assembly 12 to act as theenergy source. FIG. 18A and accompanying disclosures provide one exampleof such implementations.

In some embodiments, the electrosurgery/RF generator module 23 may beconfigured to generate a therapeutic and/or a sub-therapeutic energylevel. In the example embodiment illustrated in FIG. 1, the generator 20includes a control system 25 integral with the generator 20, and a footswitch 29 connected to the generator via a cable 27. The generator 20may also comprise a triggering mechanism for activating a surgicalinstrument, such as the instrument 10. The triggering mechanism mayinclude a power switch (not shown) as well as a foot switch 29. Whenactivated by the foot switch 29, the generator 20 may provide energy todrive the acoustic assembly of the surgical instrument 10 and to drivethe end effector 18 at a predetermined excursion level. The generator 20drives or excites the acoustic assembly at any suitable resonantfrequency of the acoustic assembly and/or derives thetherapeutic/sub-therapeutic electromagnetic/RF energy.

In one embodiment, the electrosurgical/RF generator module 23 may beimplemented as an electrosurgery unit (ESU) capable of supplying powersufficient to perform bipolar electrosurgery using radio frequency (RF)energy. In one embodiment, the ESU can be a bipolar ERBE ICC 350 sold byERBE USA, Inc. of Marietta, Ga. In bipolar electrosurgery applications,as previously discussed, a surgical instrument having an activeelectrode and a return electrode can be utilized, wherein the activeelectrode and the return electrode can be positioned against, oradjacent to, the tissue to be treated such that current can flow fromthe active electrode to the return electrode through the tissue.Accordingly, the electrosurgical/RF module 23 generator may beconfigured for therapeutic purposes by applying electrical energy to thetissue T sufficient for treating the tissue (e.g., cauterization).

In one embodiment, the electrosurgical/RF generator module 23 may beconfigured to deliver a sub-therapeutic RF signal to implement a tissueimpedance measurement module. In one embodiment, the electrosurgical/RFgenerator module 23 comprises a bipolar radio frequency generator asdescribed in more detail below. In one embodiment, theelectrosurgical/RF generator module 12 may be configured to monitorelectrical impedance Z, of tissue T and to control the characteristicsof time and power level based on the tissue T by way of a returnelectrode on provided on a clamp member of the end effector assembly 26.Accordingly, the electrosurgical/RF generator module 23 may beconfigured for sub-therapeutic purposes for measuring the impedance orother electrical characteristics of the tissue T. Techniques and circuitconfigurations for measuring the impedance or other electricalcharacteristics of tissue T are discussed in more detail in commonlyassigned U.S. Patent Publication No. 2011/0015631, titled“Electrosurgical Generator for Ultrasonic Surgical Instruments,” thedisclosure of which is herein incorporated by reference in its entirety.

A suitable ultrasonic generator module 21 may be configured tofunctionally operate in a manner similar to the GEN300 sold by EthiconEndo-Surgery, Inc. of Cincinnati, Ohio as is disclosed in one or more ofthe following U.S. patents, all of which are incorporated by referenceherein: U.S. Pat. No. 6,480,796 (Method for Improving the Start Up of anUltrasonic System Under Zero Load Conditions); U.S. Pat. No. 6,537,291(Method for Detecting Blade Breakage Using Rate and/or ImpedanceInformation); U.S. Pat. No. 6,662,127 (Method for Detecting Presence ofa Blade in an Ultrasonic System); U.S. Pat. No. 6,679,899 (Method forDetecting Transverse Vibrations in an Ultrasonic Hand Piece); U.S. Pat.No. 6,977,495 (Detection Circuitry for Surgical Handpiece System); U.S.Pat. No. 7,077,853 (Method for Calculating Transducer Capacitance toDetermine Transducer Temperature); U.S. Pat. No. 7,179,271 (Method forDriving an Ultrasonic System to Improve Acquisition of Blade ResonanceFrequency at Startup); and U.S. Pat. No. 7,273,483 (Apparatus and Methodfor Alerting Generator Function in an Ultrasonic Surgical System).

It will be appreciated that in various embodiments, the generator 20 maybe configured to operate in several modes. In one mode, the generator 20may be configured such that the ultrasonic generator module 21 and theelectrosurgical/RF generator module 23 may be operated independently.

For example, the ultrasonic generator module 21 may be activated toapply ultrasonic energy to the end effector assembly 26 andsubsequently, either therapeutic sub-therapeutic RF energy may beapplied to the end effector assembly 26 by the electrosurgical/RFgenerator module 23. As previously discussed, the subtherapeuticelectrosurgical/RF energy may be applied to tissue clamped between claimelements of the end effector assembly 26 to measure tissue impedance tocontrol the activation, or modify the activation, of the ultrasonicgenerator module 21. Tissue impedance feedback from the application ofthe subtherapeutic energy also may be employed to activate a therapeuticlevel of the electrosurgical/RF generator module 23 to seal the tissue(e.g., vessel) clamped between claim elements of the end effectorassembly 26.

In another embodiment, the ultrasonic generator module 21 and theelectrosurgical/RF generator module 23 may be activated simultaneously.In one example, the ultrasonic generator module 21 is simultaneouslyactivated with a sub-therapeutic RF energy level to measure tissueimpedance simultaneously while the ultrasonic blade of the end effectorassembly 26 cuts and coagulates the tissue (or vessel) clamped betweenthe clamp elements of the end effector assembly 26. Such feedback may beemployed, for example, to modify the drive output of the ultrasonicgenerator module 21. In another example, the ultrasonic generator module21 may be driven simultaneously with electrosurgical/RF generator module23 such that the ultrasonic blade portion of the end effector assembly26 is employed for cutting the damaged tissue while theelectrosurgical/RF energy is applied to electrode portions of the endeffector clamp assembly 26 for sealing the tissue (or vessel).

When the generator 20 is activated via the triggering mechanism, in oneembodiment electrical energy is continuously applied by the generator 20to a transducer stack or assembly of the acoustic assembly. In anotherembodiment, electrical energy is intermittently applied (e.g., pulsed)by the generator 20. A phase-locked loop in the control system of thegenerator 20 may monitor feedback from the acoustic assembly. The phaselock loop adjusts the frequency of the electrical energy sent by thegenerator 20 to match the resonant frequency of the selectedlongitudinal mode of vibration of the acoustic assembly. In addition, asecond feedback loop in the control system 25 maintains the electricalcurrent supplied to the acoustic assembly at a pre-selected constantlevel in order to achieve substantially constant excursion at the endeffector 18 of the acoustic assembly. In yet another embodiment, a thirdfeedback loop in the control system 25 monitors impedance betweenelectrodes located in the end effector assembly 26. Although FIGS. 1-9show a manually operated ultrasonic surgical instrument, it will beappreciated that ultrasonic surgical instruments may also be used inrobotic applications, for example, as described herein, as well ascombinations of manual and robotic applications.

In ultrasonic operation mode, the electrical signal supplied to theacoustic assembly may cause the distal end of the end effector 18, tovibrate longitudinally in the range of, for example, approximately 20kHz to 250 kHz. According to various embodiments, the blade 22 mayvibrate in the range of about 54 kHz to 56 kHz, for example, at about55.5 kHz. In other embodiments, the blade 22 may vibrate at otherfrequencies including, for example, about 31 kHz or about 80 kHz. Theexcursion of the vibrations at the blade can be controlled by, forexample, controlling the amplitude of the electrical signal applied tothe transducer assembly of the acoustic assembly by the generator 20. Asnoted above, the triggering mechanism of the generator 20 allows a userto activate the generator 20 so that electrical energy may becontinuously or intermittently supplied to the acoustic assembly. Thegenerator 20 also has a power line for insertion in an electro-surgicalunit or conventional electrical outlet. It is contemplated that thegenerator 20 can also be powered by a direct current (DC) source, suchas a battery. The generator 20 can comprise any suitable generator, suchas Model No. GEN04, and/or Model No. GEN11 available from EthiconEndo-Surgery, Inc.

FIG. 2 is a left perspective view of one example embodiment of theultrasonic surgical instrument 10 showing the handle assembly 12, thedistal rotation assembly 13, the elongated shaft assembly 14, and theend effector assembly 26. In the illustrated embodiment the elongatedshaft assembly 14 comprises a distal end 52 dimensioned to mechanicallyengage the end effector assembly 26 and a proximal end 50 thatmechanically engages the handle assembly 12 and the distal rotationassembly 13. The proximal end 50 of the elongated shaft assembly 14 isreceived within the handle assembly 12 and the distal rotation assembly13. More details relating to the connections between the elongated shaftassembly 14, the handle assembly 12, and the distal rotation assembly 13are provided in the description of FIGS. 5 and 7.

In the illustrated embodiment, the trigger assembly 24 comprises atrigger 32 that operates in conjunction with a fixed handle 34. Thefixed handle 34 and the trigger 32 are ergonomically formed and adaptedto interface comfortably with the user. The fixed handle 34 isintegrally associated with the handle assembly 12. The trigger 32 ispivotally movable relative to the fixed handle 34 as explained in moredetail below with respect to the operation of the ultrasonic surgicalinstrument 10. The trigger 32 is pivotally movable in direction 33Atoward the fixed handle 34 when the user applies a squeezing forceagainst the trigger 32. A spring element 98 (FIG. 5) causes the trigger32 to pivotally move in direction 33B when the user releases thesqueezing force against the trigger 32.

In one example embodiment, the trigger 32 comprises an elongated triggerhook 36, which defines an aperture 38 between the elongated trigger hook36 and the trigger 32. The aperture 38 is suitably sized to receive oneor multiple fingers of the user therethrough. The trigger 32 also maycomprise a resilient portion 32 a molded over the trigger 32 substrate.The overmolded resilient portion 32 a is formed to provide a morecomfortable contact surface for control of the trigger 32 in outwarddirection 33B. In one example embodiment, the overmolded resilientportion 32 a may be provided over a portion of the elongated triggerhook 36. The proximal surface of the elongated trigger hook 32 remainsuncoated or coated with a non-resilient substrate to enable the user toeasily slide their fingers in and out of the aperture 38. In anotherembodiment, the geometry of the trigger forms a fully closed loop whichdefines an aperture suitably sized to receive one or multiple fingers ofthe user therethrough. The fully closed loop trigger also may comprise aresilient portion molded over the trigger substrate.

In one example embodiment, the fixed handle 34 comprises a proximalcontact surface 40 and a grip anchor or saddle surface 42. The saddlesurface 42 rests on the web where the thumb and the index finger arejoined on the hand. The proximal contact surface 40 has a pistol gripcontour that receives the palm of the hand in a normal pistol grip withno rings or apertures. The profile curve of the proximal contact surface40 may be contoured to accommodate or receive the palm of the hand. Astabilization tail 44 is located towards a more proximal portion of thehandle assembly 12. The stabilization tail 44 may be in contact with theuppermost web portion of the hand located between the thumb and theindex finger to stabilize the handle assembly 12 and make the handleassembly 12 more controllable.

In one example embodiment, the switch assembly 28 may comprise a toggleswitch 30. The toggle switch 30 may be implemented as a single componentwith a central pivot 304 located within inside the handle assembly 12 toeliminate the possibility of simultaneous activation. In one exampleembodiment, the toggle switch 30 comprises a first projecting knob 30 aand a second projecting knob 30 b to set the power setting of theultrasonic transducer 16 between a minimum power level (e.g., MIN) and amaximum power level (e.g., MAX). In another embodiment, the rockerswitch may pivot between a standard setting and a special setting. Thespecial setting may allow one or more special programs to be implementedby the device. The toggle switch 30 rotates about the central pivot asthe first projecting knob 30 a and the second projecting knob 30 b areactuated. The one or more projecting knobs 30 a, 30 b are coupled to oneor more arms that move through a small arc and cause electrical contactsto close or open an electric circuit to electrically energize orde-energize the ultrasonic transducer 16 in accordance with theactivation of the first or second projecting knobs 30 a, 30 b. Thetoggle switch 30 is coupled to the generator 20 to control theactivation of the ultrasonic transducer 16. The toggle switch 30comprises one or more electrical power setting switches to activate theultrasonic transducer 16 to set one or more power settings for theultrasonic transducer 16. The forces required to activate the toggleswitch 30 are directed substantially toward the saddle point 42, thusavoiding any tendency of the instrument to rotate in the hand when thetoggle switch 30 is activated.

In one example embodiment, the first and second projecting knobs 30 a,30 b are located on the distal end of the handle assembly 12 such thatthey can be easily accessible by the user to activate the power withminimal, or substantially no, repositioning of the hand grip, making itsuitable to maintain control and keep attention focused on the surgicalsite (e.g., a monitor in a laparoscopic procedure) while activating thetoggle switch 30. The projecting knobs 30 a, 30 b may be configured towrap around the side of the handle assembly 12 to some extent to be moreeasily accessible by variable finger lengths and to allow greaterfreedom of access to activation in awkward positions or for shorterfingers.

In the illustrated embodiment, the first projecting knob 30 a comprisesa plurality of tactile elements 30 c, e.g., textured projections or“bumps” in the illustrated embodiment, to allow the user todifferentiate the first projecting knob 30 a from the second projectingknob 30 b. It will be appreciated by those skilled in the art thatseveral ergonomic features may be incorporated into the handle assembly12. Such ergonomic features are described in U.S. Pat. App. Pub. No.2009/0105750, now U.S. Pat. No. 8,623,027 entitled “Ergonomic SurgicalInstruments” which is incorporated by reference herein in its entirety.

In one example embodiment, the toggle switch 30 may be operated by thehand of the user. The user may easily access the first and secondprojecting knobs 30 a, 30 b at any point while also avoiding inadvertentor unintentional activation at any time. The toggle switch 30 mayreadily operated with a finger to control the power to the ultrasonicassembly 16 and/or to the ultrasonic assembly 16. For example, the indexfinger may be employed to activate the first contact portion 30 a toturn on the ultrasonic assembly 16 to a maximum (MAX) power level. Theindex finger may be employed to activate the second contact portion 30 bto turn on the ultrasonic assembly 16 to a minimum (MIN) power level. Inanother embodiment, the rocker switch may pivot the instrument 10between a standard setting and a special setting. The special settingmay allow one or more special programs to be implemented by theinstrument 10. The toggle switch 30 may be operated without the userhaving to look at the first or second projecting knob 30 a, 30 b. Forexample, the first projecting knob 30 a or the second projecting knob 30b may comprise a texture or projections to tactilely differentiatebetween the first and second projecting knobs 30 a, 30 b withoutlooking.

In other embodiments, the trigger 32 and/or the toggle switch 30 may beemployed to actuate the electrosurgical/RF generator module 23individually or in combination with activation of the ultrasonicgenerator module 21.

In one example embodiment, the distal rotation assembly 13 is rotatablewithout limitation in either direction about a longitudinal axis “T.”The distal rotation assembly 13 is mechanically engaged to the elongatedshaft assembly 14. The distal rotation assembly 13 is located on adistal end of the handle assembly 12. The distal rotation assembly 13comprises a cylindrical hub 46 and a rotation knob 48 formed over thehub 46. The hub 46 mechanically engages the elongated shaft assembly 14.The rotation knob 48 may comprise fluted polymeric features and may beengaged by a finger (e.g., an index finger) to rotate the elongatedshaft assembly 14. The hub 46 may comprise a material molded over theprimary structure to form the rotation knob 48. The rotation knob 48 maybe overmolded over the hub 46. The hub 46 comprises an end cap portion46 a that is exposed at the distal end. The end cap portion 46 a of thehub 46 may contact the surface of a trocar during laparoscopicprocedures. The hub 46 may be formed of a hard durable plastic such aspolycarbonate to alleviate any friction that may occur between the endcap portion 46 a and the trocar. The rotation knob 48 may comprise“scallops” or flutes formed of raised ribs 48 a and concave portions 48b located between the ribs 48 a to provide a more precise rotationalgrip. In one example embodiment, the rotation knob 48 may comprise aplurality of flutes (e.g., three or more flutes). In other embodiments,any suitable number of flutes may be employed. The rotation knob 48 maybe formed of a softer polymeric material overmolded onto the hardplastic material. For example, the rotation knob 48 may be formed ofpliable, resilient, flexible polymeric materials including Versaflex®TPE alloys made by GLS Corporation, for example. This softer overmoldedmaterial may provide a greater grip and more precise control of themovement of the rotation knob 48. It will be appreciated that anymaterials that provide adequate resistance to sterilization, arebiocompatible, and provide adequate frictional resistance to surgicalgloves may be employed to form the rotation knob 48.

In one example embodiment, the handle assembly 12 is formed from two (2)housing portions or shrouds comprising a first portion 12 a and a secondportion 12 b. From the perspective of a user viewing the handle assembly12 from the distal end towards the proximal end, the first portion 12 ais considered the right portion and the second portion 12 b isconsidered the left portion. Each of the first and second portions 12 a,12 b includes a plurality of interfaces 69 (FIG. 5) dimensioned tomechanically align and engage each another to form the handle assembly12 and enclosing the internal working components thereof. The fixedhandle 34, which is integrally associated with the handle assembly 12,takes shape upon the assembly of the first and second portions 12 a and12 b of the handle assembly 12. A plurality of additional interfaces(not shown) may be disposed at various points around the periphery ofthe first and second portions 12 a and 12 b of the handle assembly 12for ultrasonic welding purposes, e.g., energy direction/deflectionpoints. The first and second portions 12 a and 12 b (as well as theother components described below) may be assembled together in anyfashion known in the art. For example, alignment pins, snap-likeinterfaces, tongue and groove interfaces, locking tabs, adhesive ports,may all be utilized either alone or in combination for assemblypurposes.

In one example embodiment, the elongated shaft assembly 14 comprises aproximal end 50 adapted to mechanically engage the handle assembly 12and the distal rotation assembly 13; and a distal end 52 adapted tomechanically engage the end effector assembly 26. The elongated shaftassembly 14 comprises an outer tubular sheath 56 and a reciprocatingtubular actuating member 58 located within the outer tubular sheath 56.The proximal end of the tubular reciprocating tubular actuating member58 is mechanically engaged to the trigger 32 of the handle assembly 12to move in either direction 60A or 60B in response to the actuationand/or release of the trigger 32. The pivotably moveable trigger 32 maygenerate reciprocating motion along the longitudinal axis “T.” Suchmotion may be used, for example, to actuate the jaws or clampingmechanism of the end effector assembly 26. A series of linkagestranslate the pivotal rotation of the trigger 32 to axial movement of ayoke coupled to an actuation mechanism, which controls the opening andclosing of the jaws of the clamping mechanism of the end effectorassembly 26. The distal end of the tubular reciprocating tubularactuating member 58 is mechanically engaged to the end effector assembly26. In the illustrated embodiment, the distal end of the tubularreciprocating tubular actuating member 58 is mechanically engaged to aclamp arm assembly 64, which is pivotable about a pivot point 70, toopen and close the clamp arm assembly 64 in response to the actuationand/or release of the trigger 32. For example, in the illustratedembodiment, the clamp arm assembly 64 is movable in direction 62A froman open position to a closed position about a pivot point 70 when thetrigger 32 is squeezed in direction 33A. The clamp arm assembly 64 ismovable in direction 62B from a closed position to an open positionabout the pivot point 70 when the trigger 32 is released or outwardlycontacted in direction 33B.

In one example embodiment, the end effector assembly 26 is attached atthe distal end 52 of the elongated shaft assembly 14 and includes aclamp arm assembly 64 and a blade 66. The jaws of the clamping mechanismof the end effector assembly 26 are formed by clamp arm assembly 64 andthe blade 66. The blade 66 is ultrasonically actuatable and isacoustically coupled to the ultrasonic transducer 16. The trigger 32 onthe handle assembly 12 is ultimately connected to a drive assembly,which together, mechanically cooperate to effect movement of the clamparm assembly 64. Squeezing the trigger 32 in direction 33A moves theclamp arm assembly 64 in direction 62A from an open position, whereinthe clamp arm assembly 64 and the blade 66 are disposed in a spacedrelation relative to one another, to a clamped or closed position,wherein the clamp arm assembly 64 and the blade 66 cooperate to grasptissue therebetween. The clamp arm assembly 64 may comprise a clamp pad69 to engage tissue between the blade 66 and the clamp arm 64. Releasingthe trigger 32 in direction 33B moves the clamp arm assembly 64 indirection 62B from a closed relationship, to an open position, whereinthe clamp arm assembly 64 and the blade 66 are disposed in a spacedrelation relative to one another.

The proximal portion of the handle assembly 12 comprises a proximalopening 68 to receive the distal end of the ultrasonic assembly 16. Theultrasonic assembly 16 is inserted in the proximal opening 68 and ismechanically engaged to the elongated shaft assembly 14.

In one example embodiment, the elongated trigger hook 36 portion of thetrigger 32 provides a longer trigger lever with a shorter span androtation travel. The longer lever of the elongated trigger hook 36allows the user to employ multiple fingers within the aperture 38 tooperate the elongated trigger hook 36 and cause the trigger 32 to pivotin direction 33B to open the jaws of the end effector assembly 26. Forexample, the user may insert three fingers (e.g., the middle, ring, andlittle fingers) in the aperture 38. Multiple fingers allows the surgeonto exert higher input forces on the trigger 32 and the elongated triggerhook 36 to activate the end effector assembly 26. The shorter span androtation travel creates a more comfortable grip when closing orsqueezing the trigger 32 in direction 33A or when opening the trigger 32in the outward opening motion in direction 33B lessening the need toextend the fingers further outward. This substantially lessens handfatigue and strain associated with the outward opening motion of thetrigger 32 in direction 33B. The outward opening motion of the triggermay be spring-assisted by spring element 98 (FIG. 5) to help alleviatefatigue. The opening spring force is sufficient to assist the ease ofopening, but not strong enough to adversely impact the tactile feedbackof tissue tension during spreading dissection.

For example, during a surgical procedure either the index finger may beused to control the rotation of the elongated shaft assembly 14 tolocate the jaws of the end effector assembly 26 in a suitableorientation. The middle and/or the other lower fingers may be used tosqueeze the trigger 32 and grasp tissue within the jaws. Once the jawsare located in the desired position and the jaws are clamped against thetissue, the index finger can be used to activate the toggle switch 30 toadjust the power level of the ultrasonic transducer 16 to treat thetissue. Once the tissue has been treated, the user the may release thetrigger 32 by pushing outwardly in the distal direction against theelongated trigger hook 36 with the middle and/or lower fingers to openthe jaws of the end effector assembly 26. This basic procedure may beperformed without the user having to adjust their grip of the handleassembly 12.

FIGS. 3-4 illustrate the connection of the elongated shaft assembly 14relative to the end effector assembly 26. As previously described, inthe illustrated embodiment, the end effector assembly 26 comprises aclamp arm assembly 64 and a blade 66 to form the jaws of the clampingmechanism. The blade 66 may be an ultrasonically actuatable bladeacoustically coupled to the ultrasonic transducer 16. The trigger 32 ismechanically connected to a drive assembly. Together, the trigger 32 andthe drive assembly mechanically cooperate to move the clamp arm assembly64 to an open position in direction 62A wherein the clamp arm assembly64 and the blade 66 are disposed in spaced relation relative to oneanother, to a clamped or closed position in direction 62B wherein theclamp arm assembly 64 and the blade 66 cooperate to grasp tissuetherebetween. The clamp arm assembly 64 may comprise a clamp pad 69 toengage tissue between the blade 66 and the clamp arm 64. The distal endof the tubular reciprocating tubular actuating member 58 is mechanicallyengaged to the end effector assembly 26. In the illustrated embodiment,the distal end of the tubular reciprocating tubular actuating member 58is mechanically engaged to the clamp arm assembly 64, which is pivotableabout the pivot point 70, to open and close the clamp arm assembly 64 inresponse to the actuation and/or release of the trigger 32. For example,in the illustrated embodiment, the clamp arm assembly 64 is movable froman open position to a closed position in direction 62B about a pivotpoint 70 when the trigger 32 is squeezed in direction 33A. The clamp armassembly 64 is movable from a closed position to an open position indirection 62A about the pivot point 70 when the trigger 32 is releasedor outwardly contacted in direction 33B.

As previously discussed, the clamp arm assembly 64 may compriseelectrodes electrically coupled to the electrosurgical/RF generatormodule 23 to receive therapeutic and/or sub-therapeutic energy, wherethe electrosurgical/RF energy may be applied to the electrodes eithersimultaneously or non-simultaneously with the ultrasonic energy beingapplied to the blade 66. Such energy activations may be applied in anysuitable combinations to achieve a desired tissue effect in cooperationwith an algorithm or other control logic.

FIG. 5 is an exploded view of the ultrasonic surgical instrument 10shown in FIG. 2. In the illustrated embodiment, the exploded view showsthe internal elements of the handle assembly 12, the handle assembly 12,the distal rotation assembly 13, the switch assembly 28, and theelongated shaft assembly 14. In the illustrated embodiment, the firstand second portions 12 a, 12 b mate to form the handle assembly 12. Thefirst and second portions 12 a, 12 b each comprises a plurality ofinterfaces 69 dimensioned to mechanically align and engage one anotherto form the handle assembly 12 and enclose the internal workingcomponents of the ultrasonic surgical instrument 10. The rotation knob48 is mechanically engaged to the outer tubular sheath 56 so that it maybe rotated in circular direction 54 up to 360°. The outer tubular sheath56 is located over the reciprocating tubular actuating member 58, whichis mechanically engaged to and retained within the handle assembly 12via a plurality of coupling elements 72. The coupling elements 72 maycomprise an O-ring 72 a, a tube collar cap 72 b, a distal washer 72 c, aproximal washer 72 d, and a thread tube collar 72 e. The reciprocatingtubular actuating member 58 is located within a reciprocating yoke 84,which is retained between the first and second portions 12 a, 12 b ofthe handle assembly 12. The yoke 84 is part of a reciprocating yokeassembly 88. A series of linkages translate the pivotal rotation of theelongated trigger hook 32 to the axial movement of the reciprocatingyoke 84, which controls the opening and closing of the jaws of theclamping mechanism of the end effector assembly 26 at the distal end ofthe ultrasonic surgical instrument 10. In one example embodiment, afour-link design provides mechanical advantage in a relatively shortrotation span, for example.

In one example embodiment, an ultrasonic transmission waveguide 78 isdisposed inside the reciprocating tubular actuating member 58. Thedistal end 52 of the ultrasonic transmission waveguide 78 isacoustically coupled (e.g., directly or indirectly mechanically coupled)to the blade 66 and the proximal end 50 of the ultrasonic transmissionwaveguide 78 is received within the handle assembly 12. The proximal end50 of the ultrasonic transmission waveguide 78 is adapted toacoustically couple to the distal end of the ultrasonic transducer 16 asdiscussed in more detail below. The ultrasonic transmission waveguide 78is isolated from the other elements of the elongated shaft assembly 14by a protective sheath 80 and a plurality of isolation elements 82, suchas silicone rings. The outer tubular sheath 56, the reciprocatingtubular actuating member 58, and the ultrasonic transmission waveguide78 are mechanically engaged by a pin 74. The switch assembly 28comprises the toggle switch 30 and electrical elements 86 a,b toelectrically energize the ultrasonic transducer 16 in accordance withthe activation of the first or second projecting knobs 30 a, 30 b.

In one example embodiment, the outer tubular sheath 56 isolates the useror the patient from the ultrasonic vibrations of the ultrasonictransmission waveguide 78. The outer tubular sheath 56 generallyincludes a hub 76. The outer tubular sheath 56 is threaded onto thedistal end of the handle assembly 12. The ultrasonic transmissionwaveguide 78 extends through the opening of the outer tubular sheath 56and the isolation elements 82 isolate the ultrasonic transmissionwaveguide 24 from the outer tubular sheath 56. The outer tubular sheath56 may be attached to the waveguide 78 with the pin 74. The hole toreceive the pin 74 in the waveguide 78 may occur nominally at adisplacement node. The waveguide 78 may screw or snap into the handpiece handle assembly 12 by a stud. Flat portions on the hub 76 mayallow the assembly to be torqued to a required level. In one exampleembodiment, the hub 76 portion of the outer tubular sheath 56 ispreferably constructed from plastic and the tubular elongated portion ofthe outer tubular sheath 56 is fabricated from stainless steel.Alternatively, the ultrasonic transmission waveguide 78 may comprisepolymeric material surrounding it to isolate it from outside contact.

In one example embodiment, the distal end of the ultrasonic transmissionwaveguide 78 may be coupled to the proximal end of the blade 66 by aninternal threaded connection, preferably at or near an antinode. It iscontemplated that the blade 66 may be attached to the ultrasonictransmission waveguide 78 by any suitable means, such as a welded jointor the like. Although the blade 66 may be detachable from the ultrasonictransmission waveguide 78, it is also contemplated that the singleelement end effector (e.g., the blade 66) and the ultrasonictransmission waveguide 78 may be formed as a single unitary piece.

In one example embodiment, the trigger 32 is coupled to a linkagemechanism to translate the rotational motion of the trigger 32 indirections 33A and 33B to the linear motion of the reciprocating tubularactuating member 58 in corresponding directions 60A and 60B. The trigger32 comprises a first set of flanges 98 with openings formed therein toreceive a first yoke pin 92 a. The first yoke pin 92 a is also locatedthrough a set of openings formed at the distal end of the yoke 84. Thetrigger 32 also comprises a second set of flanges 96 to receive a firstend 92 a of a link 92. A trigger pin 90 is received in openings formedin the link 92 and the second set of flanges 96. The trigger pin 90 isreceived in the openings formed in the link 92 and the second set offlanges 96 and is adapted to couple to the first and second portions 12a, 12 b of the handle assembly 12 to form a trigger pivot point for thetrigger 32. A second end 92 b of the link 92 is received in a slot 384formed in a proximal end of the yoke 84 and is retained therein by asecond yoke pin 94 b. As the trigger 32 is pivotally rotated about thepivot point 190 formed by the trigger pin 90, the yoke translateshorizontally along longitudinal axis “T” in a direction indicated byarrows 60A,B.

FIG. 8 illustrates one example embodiment of an ultrasonic surgicalinstrument 10. In the illustrated embodiment, a cross-sectional view ofthe ultrasonic transducer 16 is shown within a partial cutaway view ofthe handle assembly 12. One example embodiment of the ultrasonicsurgical instrument 10 comprises the ultrasonic signal generator 20coupled to the ultrasonic transducer 16, comprising a hand piece housing99, and an ultrasonically actuatable single or multiple element endeffector assembly 26. As previously discussed, the end effector assembly26 comprises the ultrasonically actuatable blade 66 and the clamp arm64. The ultrasonic transducer 16, which is known as a “Langevin stack”,generally includes a transduction portion 100, a first resonator portionor end-bell 102, and a second resonator portion or fore-bell 104, andancillary components. The total construction of these components is aresonator. The ultrasonic transducer 16 is preferably an integral numberof one-half system wavelengths (nλ/2; where “n” is any positive integer;e.g., n=1, 2, 3 . . . ) in length as will be described in more detaillater. An acoustic assembly 106 includes the ultrasonic transducer 16, anose cone 108, a velocity transformer 118, and a surface 110.

In one example embodiment, the distal end of the end-bell 102 isconnected to the proximal end of the transduction portion 100, and theproximal end of the fore-bell 104 is connected to the distal end of thetransduction portion 100. The fore-bell 104 and the end-bell 102 have alength determined by a number of variables, including the thickness ofthe transduction portion 100, the density and modulus of elasticity ofthe material used to manufacture the end-bell 102 and the fore-bell 22,and the resonant frequency of the ultrasonic transducer 16. Thefore-bell 104 may be tapered inwardly from its proximal end to itsdistal end to amplify the ultrasonic vibration amplitude as the velocitytransformer 118, or alternately may have no amplification. A suitablevibrational frequency range may be about 20 Hz to 32 kHz and awell-suited vibrational frequency range may be about 30-10 kHz. Asuitable operational vibrational frequency may be approximately 55.5kHz, for example.

In one example embodiment, the piezoelectric elements 112 may befabricated from any suitable material, such as, for example, leadzirconate-titanate, lead meta-niobate, lead titanate, barium titanate,or other piezoelectric ceramic material. Each of positive electrodes114, negative electrodes 116, and the piezoelectric elements 112 has abore extending through the center. The positive and negative electrodes114 and 116 are electrically coupled to wires 120 and 122, respectively.The wires 120 and 122 are encased within the cable 22 and electricallyconnectable to the ultrasonic signal generator 20.

The ultrasonic transducer 16 of the acoustic assembly 106 converts theelectrical signal from the ultrasonic signal generator 20 intomechanical energy that results in primarily a standing acoustic wave oflongitudinal vibratory motion of the ultrasonic transducer 16 and theblade 66 portion of the end effector assembly 26 at ultrasonicfrequencies. In another embodiment, the vibratory motion of theultrasonic transducer may act in a different direction. For example, thevibratory motion may comprise a local longitudinal component of a morecomplicated motion of the tip of the elongated shaft assembly 14. Asuitable generator is available as model number GEN11, from EthiconEndo-Surgery, Inc., Cincinnati, Ohio. When the acoustic assembly 106 isenergized, a vibratory motion standing wave is generated through theacoustic assembly 106. The ultrasonic surgical instrument 10 is designedto operate at a resonance such that an acoustic standing wave pattern ofpredetermined amplitude is produced. The amplitude of the vibratorymotion at any point along the acoustic assembly 106 depends upon thelocation along the acoustic assembly 106 at which the vibratory motionis measured. A minimum or zero crossing in the vibratory motion standingwave is generally referred to as a node (i.e., where motion is minimal),and a local absolute value maximum or peak in the standing wave isgenerally referred to as an anti-node (e.g., where local motion ismaximal). The distance between an anti-node and its nearest node isone-quarter wavelength (λ/4).

The wires 120 and 122 transmit an electrical signal from the ultrasonicsignal generator 20 to the positive electrodes 114 and the negativeelectrodes 116. The piezoelectric elements 112 are energized by theelectrical signal supplied from the ultrasonic signal generator 20 inresponse to an actuator 224, such as a foot switch, for example, toproduce an acoustic standing wave in the acoustic assembly 106. Theelectrical signal causes disturbances in the piezoelectric elements 112in the form of repeated small displacements resulting in largealternating compression and tension forces within the material. Therepeated small displacements cause the piezoelectric elements 112 toexpand and contract in a continuous manner along the axis of the voltagegradient, producing longitudinal waves of ultrasonic energy. Theultrasonic energy is transmitted through the acoustic assembly 106 tothe blade 66 portion of the end effector assembly 26 via a transmissioncomponent or an ultrasonic transmission waveguide portion 78 of theelongated shaft assembly 14.

In one example embodiment, in order for the acoustic assembly 106 todeliver energy to the blade 66 portion of the end effector assembly 26,all components of the acoustic assembly 106 must be acoustically coupledto the blade 66. The distal end of the ultrasonic transducer 16 may beacoustically coupled at the surface 110 to the proximal end of theultrasonic transmission waveguide 78 by a threaded connection such as astud 124.

In one example embodiment, the components of the acoustic assembly 106are preferably acoustically tuned such that the length of any assemblyis an integral number of one-half wavelengths (nλ/2), where thewavelength λ is the wavelength of a pre-selected or operatinglongitudinal vibration drive frequency f_(d) of the acoustic assembly106. It is also contemplated that the acoustic assembly 106 mayincorporate any suitable arrangement of acoustic elements.

In one example embodiment, the blade 66 may have a length substantiallyequal to an integral multiple of one-half system wavelengths (nλ/2). Adistal end of the blade 66 may be disposed near an antinode in order toprovide the maximum longitudinal excursion of the distal end. When thetransducer assembly is energized, the distal end of the blade 66 may beconfigured to move in the range of, for example, approximately 10 to 500microns peak-to-peak, and preferably in the range of about 30 to 64microns at a predetermined vibrational frequency of 55 kHz, for example.

In one example embodiment, the blade 66 may be coupled to the ultrasonictransmission waveguide 78. The blade 66 and the ultrasonic transmissionwaveguide 78 as illustrated are formed as a single unit constructionfrom a material suitable for transmission of ultrasonic energy. Examplesof such materials include Ti6Al4V (an alloy of Titanium includingAluminum and Vanadium), Aluminum, Stainless Steel, or other suitablematerials. Alternately, the blade 66 may be separable (and of differingcomposition) from the ultrasonic transmission waveguide 78, and coupledby, for example, a stud, weld, glue, quick connect, or other suitableknown methods. The length of the ultrasonic transmission waveguide 78may be substantially equal to an integral number of one-half wavelengths(nλ/2), for example. The ultrasonic transmission waveguide 78 may bepreferably fabricated from a solid core shaft constructed out ofmaterial suitable to propagate ultrasonic energy efficiently, such asthe titanium alloy discussed above (i.e., Ti6Al4V) or any suitablealuminum alloy, or other alloys, for example.

In one example embodiment, the ultrasonic transmission waveguide 78comprises a longitudinally projecting attachment post at a proximal endto couple to the surface 110 of the ultrasonic transmission waveguide 78by a threaded connection such as the stud 124. The ultrasonictransmission waveguide 78 may include a plurality of stabilizingsilicone rings or compliant supports 82 (FIG. 5) positioned at aplurality of nodes. The silicone rings 82 dampen undesirable vibrationand isolate the ultrasonic energy from an outer protective sheath 80(FIG. 5) assuring the flow of ultrasonic energy in a longitudinaldirection to the distal end of the blade 66 with maximum efficiency.

FIG. 9 illustrates one example embodiment of the proximal rotationassembly 128. In the illustrated embodiment, the proximal rotationassembly 128 comprises the proximal rotation knob 134 inserted over thecylindrical hub 135. The proximal rotation knob 134 comprises aplurality of radial projections 138 that are received in correspondingslots 130 formed on a proximal end of the cylindrical hub 135. Theproximal rotation knob 134 defines an opening 142 to receive the distalend of the ultrasonic transducer 16. The radial projections 138 areformed of a soft polymeric material and define a diameter that isundersized relative to the outside diameter of the ultrasonic transducer16 to create a friction interference fit when the distal end of theultrasonic transducer 16. The polymeric radial projections 138 protruderadially into the opening 142 to form “gripper” ribs that firmly gripthe exterior housing of the ultrasonic transducer 16. Therefore, theproximal rotation knob 134 securely grips the ultrasonic transducer 16.

The distal end of the cylindrical hub 135 comprises a circumferentiallip 132 and a circumferential bearing surface 140. The circumferentiallip engages a groove formed in the housing 12 and the circumferentialbearing surface 140 engages the housing 12. Thus, the cylindrical hub135 is mechanically retained within the two housing portions (not shown)of the housing 12. The circumferential lip 132 of the cylindrical hub135 is located or “trapped” between the first and second housingportions 12 a, 12 b and is free to rotate in place within the groove.The circumferential bearing surface 140 bears against interior portionsof the housing to assist proper rotation. Thus, the cylindrical hub 135is free to rotate in place within the housing. The user engages theflutes 136 formed on the proximal rotation knob 134 with either thefinger or the thumb to rotate the cylindrical hub 135 within the housing12.

In one example embodiment, the cylindrical hub 135 may be formed of adurable plastic such as polycarbonate. In one example embodiment, thecylindrical hub 135 may be formed of a siliconized polycarbonatematerial. In one example embodiment, the proximal rotation knob 134 maybe formed of pliable, resilient, flexible polymeric materials includingVersaflex® TPE alloys made by GLS Corporation, for example. The proximalrotation knob 134 may be formed of elastomeric materials, thermoplasticrubber known as Santoprene®, other thermoplastic vulcanizates (TPVs), orelastomers, for example. The embodiments, however, are not limited inthis context.

FIG. 10 illustrates one example embodiment of a surgical system 200including a surgical instrument 210 having single element end effector278. The system 200 may include a transducer assembly 216 coupled to theend effector 278 and a sheath 256 positioned around the proximalportions of the end effector 278 as shown. The transducer assembly 216and end effector 278 may operate in a manner similar to that of thetransducer assembly 16 and end effector 18 described above to produceultrasonic energy that may be transmitted to tissue via blade 226′

FIGS. 11-18C illustrate various embodiments of surgical instruments thatutilize therapeutic and/or subtherapeutic electrical energy to treatand/or destroy tissue or provide feedback to the generators (e.g.,electrosurgical instruments). The embodiments of FIGS. 11-18C areadapted for use in a manual or hand-operated manner, althoughelectrosurgical instruments may be utilized in robotic applications aswell. FIG. 11 is a perspective view of one example embodiment of asurgical instrument system 300 comprising an electrical energy surgicalinstrument 310. The electrosurgical instrument 310 may comprise aproximal handle 312, a distal working end or end effector 326 and anintroducer or elongated shaft 314 disposed in-between.

The electrosurgical system 300 can be configured to supply energy, suchas electrical energy, ultrasonic energy, heat energy or any combinationthereof, to the tissue of a patient either independently orsimultaneously as described, for example, in connection with FIG. 1, forexample. In one example embodiment, the electrosurgical system 300includes a generator 320 in electrical communication with theelectrosurgical instrument 310. The generator 320 is connected toelectrosurgical instrument 310 via a suitable transmission medium suchas a cable 322. In one example embodiment, the generator 320 is coupledto a controller, such as a control unit 325, for example. In variousembodiments, the control unit 325 may be formed integrally with thegenerator 320 or may be provided as a separate circuit module or deviceelectrically coupled to the generator 320 (shown in phantom toillustrate this option). Although in the presently disclosed embodiment,the generator 320 is shown separate from the electrosurgical instrument310, in one example embodiment, the generator 320 (and/or the controlunit 325) may be formed integrally with the electrosurgical instrument310 to form a unitary electrosurgical system 300, where a batterylocated within the electrosurgical instrument 310 is the energy sourceand a circuit coupled to the battery produces the suitable electricalenergy, ultrasonic energy, or heat energy. One such example is describedherein below in connection with FIGS. 17-18C.

The generator 320 may comprise an input device 335 located on a frontpanel of the generator 320 console. The input device 335 may compriseany suitable device that generates signals suitable for programming theoperation of the generator 320, such as a keyboard, or input port, forexample. In one example embodiment, various electrodes in the first jaw364A and the second jaw 364B may be coupled to the generator 320. Thecable 322 may comprise multiple electrical conductors for theapplication of electrical energy to positive (+) and negative (−)electrodes of the electrosurgical instrument 310. The control unit 325may be used to activate the generator 320, which may serve as anelectrical source. In various embodiments, the generator 320 maycomprise an RF source, an ultrasonic source, a direct current source,and/or any other suitable type of electrical energy source, for example,which may be activated independently or simultaneously

In various embodiments, the electrosurgical system 300 may comprise atleast one supply conductor 331 and at least one return conductor 333,wherein current can be supplied to electrosurgical instrument 300 viathe supply conductor 331 and wherein the current can flow back to thegenerator 320 via the return conductor 333. In various embodiments, thesupply conductor 331 and the return conductor 333 may comprise insulatedwires and/or any other suitable type of conductor. In certainembodiments, as described below, the supply conductor 331 and the returnconductor 333 may be contained within and/or may comprise the cable 322extending between, or at least partially between, the generator 320 andthe end effector 326 of the electrosurgical instrument 310. In anyevent, the generator 320 can be configured to apply a sufficient voltagedifferential between the supply conductor 331 and the return conductor333 such that sufficient current can be supplied to the end effector110.

FIG. 12 is a side view of one example embodiment of the handle 312 ofthe surgical instrument 310. In FIG. 12, the handle 312 is shown withhalf of a first handle body 312A (see FIG. 11) removed to illustratevarious components within second handle body 312B. The handle 312 maycomprise a lever arm 321 (e.g., a trigger) which may be pulled along apath 33. The lever arm 321 may be coupled to an axially moveable member378 (FIGS. 13-16) disposed within elongated shaft 314 by a shuttle 384operably engaged to an extension 398 of lever arm 321. The shuttle 384may further be connected to a biasing device, such as a spring 388,which may also be connected to the second handle body 312B, to bias theshuttle 384 and thus the axially moveable member 378 in a proximaldirection, thereby urging the jaws 364A and 364B to an open position asseen in FIG. 11. Also, referring to FIGS. 11-12, a locking member 190(see FIG. 12) may be moved by a locking switch 328 (see FIG. 11) betweena locked position, where the shuttle 384 is substantially prevented frommoving distally as illustrated, and an unlocked position, where theshuttle 384 may be allowed to freely move in the distal direction,toward the elongated shaft 314. The handle 312 can be any type ofpistol-grip or other type of handle known in the art that is configuredto carry actuator levers, triggers or sliders for actuating the firstjaw 364A and the second jaw 364B. The elongated shaft 314 may have acylindrical or rectangular cross-section, for example, and can comprisea thin-wall tubular sleeve that extends from handle 312. The elongatedshaft 314 may include a bore extending therethrough for carryingactuator mechanisms, for example, the axially moveable member 378, foractuating the jaws and for carrying electrical leads for delivery ofelectrical energy to electrosurgical components of the end effector 326.

The end effector 326 may be adapted for capturing and transecting tissueand for the contemporaneously welding the captured tissue withcontrolled application of energy (e.g., RF energy). The first jaw 364Aand the second jaw 364B may close to thereby capture or engage tissueabout a longitudinal axis “T” defined by the axially moveable member378. The first jaw 364A and second jaw 364B may also apply compressionto the tissue. In some embodiments, the elongated shaft 314, along withfirst jaw 364A and second jaw 364B, can be rotated a full 360° degrees,as shown by arrow 196 (see FIG. 11), relative to handle 312. Forexample, a rotation knob 348 may be rotatable about the longitudinalaxis of the shaft 314 and may be coupled to the shaft 314 such thatrotation of the knob 348 causes corresponding rotation of the shaft 314.The first jaw 364A and the second jaw 364B can remain openable and/orcloseable while rotated.

FIG. 13 shows a perspective view of one example embodiment of the endeffector 326 with the jaws 364A, 364B open, while FIG. 14 shows aperspective view of one example embodiment of the end effector 326 withthe jaws 364A, 364B closed. As noted above, the end effector 326 maycomprise the upper first jaw 364A and the lower second jaw 364B, whichmay be straight or curved. The first jaw 364A and the second jaw 364Bmay each comprise an elongated slot or channel 362A and 362B,respectively, disposed outwardly along their respective middle portions.Further, the first jaw 364A and second jaw 364B may each havetissue-gripping elements, such as teeth 363, disposed on the innerportions of first jaw 364A and second jaw 364B. The first jaw 364A maycomprise an upper first jaw body 200A with an upper first outward-facingsurface 202A and an upper first energy delivery surface 365A. The secondjaw 364B may comprise a lower second jaw body 200B with a lower secondoutward-facing surface 202B and a lower second energy delivery surface365B. The first energy delivery surface 365A and the second energydelivery surface 365B may both extend in a “U” shape about the distalend of the end effector 326.

The lever arm 321 of the handle 312 (FIG. 12) may be adapted to actuatethe axially moveable member 378, which may also function as ajaw-closing mechanism. For example, the axially moveable member 378 maybe urged distally as the lever arm 321 is pulled proximally along thepath 33 via the shuttle 384, as shown in FIG. 12 and discussed above.FIG. 15 is a perspective view of one example embodiment of the axiallymoveable member 378 of the surgical instrument 310. The axially moveablemember 378 may comprise one or several pieces, but in any event, may bemovable or translatable with respect to the elongated shaft 314 and/orthe jaws 364A, 364B. Also, in at least one example embodiment, theaxially moveable member 378 may be made of 17-4 precipitation hardenedstainless steel. The distal end of axially moveable member 378 maycomprise a flanged “I”-beam configured to slide within the channels 362Aand 362B in jaws 364A and 364B. The axially moveable member 378 mayslide within the channels 362A, 362B to open and close the first jaw364A and the second jaw 364B. The distal end of the axially moveablemember 378 may also comprise an upper flange or “c”-shaped portion 378Aand a lower flange or “c”-shaped portion 378B. The flanges 378A and 378Brespectively define inner cam surfaces 367A and 367B for engagingoutward facing surfaces of the first jaw 364A and the second jaw 364B.The opening-closing of jaws 364A and 364B can apply very highcompressive forces on tissue using cam mechanisms which may includemovable “I-beam” axially moveable member 378 and the outward facingsurfaces 369A, 369B of jaws 364A, 364B.

More specifically, referring now to FIGS. 13-15, collectively, the innercam surfaces 367A and 367B of the distal end of axially moveable member378 may be adapted to slidably engage the first outward-facing surface369A and the second outward-facing surface 369B of the first jaw 364Aand the second jaw 364B, respectively. The channel 362A within first jaw364A and the channel 362B within the second jaw 364B may be sized andconfigured to accommodate the movement of the axially moveable member378, which may comprise a tissue-cutting element 371, for example,comprising a sharp distal edge. FIG. 14, for example, shows the distalend of the axially moveable member 378 advanced at least partiallythrough channels 362A and 362B (FIG. 13). The advancement of the axiallymoveable member 378 may close the end effector 326 from the openconfiguration shown in FIG. 13. In the closed position shown by FIG. 14,the upper first jaw 364A and lower second jaw 364B define a gap ordimension D between the first energy delivery surface 365A and secondenergy delivery surface 365B of first jaw 364A and second jaw 364B,respectively. In various embodiments, dimension D can equal from about0.0005″ to about 0.040″, for example, and in some embodiments, betweenabout 0.001″ to about 0.010″, for example. Also, the edges of the firstenergy delivery surface 365A and the second energy delivery surface 365Bmay be rounded to prevent the dissection of tissue.

FIG. 16 is a section view of one example embodiment of the end effector326 of the surgical instrument 310. The engagement, ortissue-contacting, surface 365B of the lower jaw 364B is adapted todeliver energy to tissue, at least in part, through aconductive-resistive matrix, such as a variable resistive positivetemperature coefficient (PTC) body, as discussed in more detail below.At least one of the upper and lower jaws 364A, 364B may carry at leastone electrode 373 configured to deliver the energy from the generator320 to the captured tissue. The engagement, or tissue-contacting,surface 365A of upper jaw 364A may carry a similar conductive-resistivematrix (i.e., a PTC material), or in some embodiments the surface may bea conductive electrode or an insulative layer, for example.Alternatively, the engagement surfaces of the jaws can carry any of theenergy delivery components disclosed in U.S. Pat. No. 6,773,409, filedOct. 22, 2001, entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLEDENERGY DELIVERY, the entire disclosure of which is incorporated hereinby reference.

The first energy delivery surface 365A and the second energy deliverysurface 365B may each be in electrical communication with the generator320. The first energy delivery surface 365A and the second energydelivery surface 365B may be configured to contact tissue and deliverelectrosurgical energy to captured tissue which are adapted to seal orweld the tissue. The control unit 325 regulates the electrical energydelivered by electrical generator 320 which in turn deliverselectrosurgical energy to the first energy delivery surface 365A and thesecond energy delivery surface 365B. The energy delivery may beinitiated by an activation button 328 (FIG. 12) operably engaged withthe lever arm 321 and in electrical communication with the generator 320via cable 322. In one example embodiment, the electrosurgical instrument310 may be energized by the generator 320 by way of a foot switch 329(FIG. 11). When actuated, the foot switch 329 triggers the generator 320to deliver electrical energy to the end effector 326, for example. Thecontrol unit 325 may regulate the power generated by the generator 320during activation. Although the foot switch 329 may be suitable in manycircumstances, other suitable types of switches can be used.

As mentioned above, the electrosurgical energy delivered by electricalgenerator 320 and regulated, or otherwise controlled, by the controlunit 325 may comprise radio frequency (RF) energy, or other suitableforms of electrical energy. Further, the opposing first and secondenergy delivery surfaces 365A and 365B may carry variable resistivepositive temperature coefficient (PTC) bodies that are in electricalcommunication with the generator 320 and the control unit 325.Additional details regarding electrosurgical end effectors, jaw closingmechanisms, and electrosurgical energy-delivery surfaces are describedin the following U.S. patents and published patent applications: U.S.Pat. Nos. 7,087,054; 7,083,619; 7,070,597; 7,041,102; 7,011,657;6,929,644; 6,926,716; 6,913,579; 6,905,497; 6,802,843; 6,770,072;6,656,177; 6,533,784; and 6,500,312; and U.S. Pat. App. Pub. Nos.2010/0036370 and 2009/0076506, all of which are incorporated herein intheir entirety by reference and made a part of this specification.

In one example embodiment, the generator 320 may be implemented as anelectrosurgery unit (ESU) capable of supplying power sufficient toperform bipolar electrosurgery using radio frequency (RF) energy. In oneexample embodiment, the ESU can be a bipolar ERBE ICC 350 sold by ERBEUSA, Inc. of Marietta, Ga. In some embodiments, such as for bipolarelectrosurgery applications, a surgical instrument having an activeelectrode and a return electrode can be utilized, wherein the activeelectrode and the return electrode can be positioned against, adjacentto and/or in electrical communication with, the tissue to be treatedsuch that current can flow from the active electrode, through thepositive temperature coefficient (PTC) bodies and to the returnelectrode through the tissue. Thus, in various embodiments, theelectrosurgical system 300 may comprise a supply path and a return path,wherein the captured tissue being treated completes, or closes, thecircuit. In one example embodiment, the generator 320 may be a monopolarRF ESU and the electrosurgical instrument 310 may comprise a monopolarend effector 326 in which one or more active electrodes are integrated.For such a system, the generator 320 may require a return pad inintimate contact with the patient at a location remote from theoperative site and/or other suitable return path. The return pad may beconnected via a cable to the generator 320. In other embodiments, theoperator 20 may provide subtherapeutic RF energy levels for purposes ofevaluating tissue conditions and providing feedback in theelectrosurgical system 300. Such feedback may be employed to control thetherapeutic RF energy output of the electrosurgical instrument 310.

During operation of electrosurgical instrument 300, the user generallygrasps tissue, supplies energy to the captured tissue to form a weld ora seal (e.g., by actuating button 328 and/or pedal 216), and then drivesa tissue-cutting element 371 at the distal end of the axially moveablemember 378 through the captured tissue. According to variousembodiments, the translation of the axial movement of the axiallymoveable member 378 may be paced, or otherwise controlled, to aid indriving the axially moveable member 378 at a suitable rate of travel. Bycontrolling the rate of the travel, the likelihood that the capturedtissue has been properly and functionally sealed prior to transectionwith the cutting element 371 is increased.

FIG. 17 is a perspective view of one example embodiment of a surgicalinstrument system comprising a cordless electrical energy surgicalinstrument 410. The electrosurgical system is similar to theelectrosurgical system 300. The electrosurgical system can be configuredto supply energy, such as electrical energy, ultrasonic energy, heatenergy, or any combination thereof, to the tissue of a patient eitherindependently or simultaneously as described in connection with FIGS. 1and 11, for example. The electrosurgical instrument may utilize the endeffector 326 and elongated shaft 314 described herein in conjunctionwith a cordless proximal handle 412. In one example embodiment, thehandle 412 includes a generator circuit 420 (see FIG. 18A). Thegenerator circuit 420 performs a function substantially similar to thatof generator 320. In one example embodiment, the generator circuit 420is coupled to a controller, such as a control circuit. In theillustrated embodiment, the control circuit is integrated into thegenerator circuit 420. In other embodiments, the control circuit may beseparate from the generator circuit 420.

In one example embodiment, various electrodes in the end effector 326(including jaws 364A, 364B thereof) may be coupled to the generatorcircuit 420. The control circuit may be used to activate the generator420, which may serve as an electrical source. In various embodiments,the generator 420 may comprise an RF source, an ultrasonic source, adirect current source, and/or any other suitable type of electricalenergy source, for example. In one example embodiment, a button 328 maybe provided to activate the generator circuit 420 to provide energy tothe end effectors 326, 326.

FIG. 18A is a side view of one example embodiment of the handle 412 ofthe cordless surgical instrument 410. In FIG. 18A, the handle 412 isshown with half of a first handle body removed to illustrate variouscomponents within second handle body 434. The handle 412 may comprise alever arm 424 (e.g., a trigger) which may be pulled along a path 33around a pivot point. The lever arm 424 may be coupled to an axiallymoveable member 478 disposed within elongated shaft 314 by a shuttleoperably engaged to an extension of lever arm 424. In one exampleembodiment, the lever arm 424 defines a shepherd's hook shape comprisinga distal member 424 a and a proximal member 424 b.

In one example embodiment, the cordless electrosurgical instrumentcomprises a battery 437. The battery 437 provides electrical energy tothe generator circuit 420. The battery 437 may be any battery suitablefor driving the generator circuit 420 at the desired energy levels. Inone example embodiment, the battery 437 is a 100 mAh, triple-cellLithium Ion Polymer battery. The battery may be fully charged prior touse in a surgical procedure, and may hold a voltage of about 12.6V. Thebattery 437 may have two fuses fitted to the cordless electrosurgicalinstrument 410, arranged in line with each battery terminal. In oneexample embodiment, a charging port 439 is provided to connect thebattery 437 to a DC current source (not shown).

The generator circuit 420 may be configured in any suitable manner. Insome embodiments, the generator circuit comprises an RF drive andcontrol circuit 440 and a controller circuit 482. FIG. 18B illustratesan RF drive and control circuit 440, according to one embodiment. FIG.18B is a part schematic part block diagram illustrating the RF drive andcontrol circuitry 440 used in this embodiment to generate and controlthe RF electrical energy supplied to the end effector 326. As will beexplained in more detail below, in this embodiment, the drive circuitry440 is a resonant mode RF amplifier comprising a parallel resonantnetwork on the RF amplifier output and the control circuitry operates tocontrol the operating frequency of the drive signal so that it ismaintained at the resonant frequency of the drive circuit, which in turncontrols the amount of power supplied to the end effector 326. The waythat this is achieved will become apparent from the followingdescription.

As shown in FIG. 18B, the RF drive and control circuit 440 comprises theabove described battery 437 are arranged to supply, in this example,about 0V and about 12V rails. An input capacitor (C_(in)) 442 isconnected between the 0V and the 12V for providing a low sourceimpedance. A pair of FET switches 443-1 and 443-2 (both of which areN-channel in this embodiment to reduce power losses) is connected inseries between the 0V rail and the 12V rail. FET gate drive circuitry805 is provided that generates two drive signals—one for driving each ofthe two FETs 443. The FET gate drive circuitry 445 generates drivesignals that causes the upper FET (443-1) to be on when the lower FET(443-2) is off and vice versa. This causes the node 447 to bealternately connected to the 12V rail (when the FET 443-1 is switchedon) and the 0V rail (when the FET 443-2 is switched on). FIG. 18B alsoshows the internal parasitic diodes 448-1 and 448-2 of the correspondingFETs 443, which conduct during any periods that the FETs 443 are open.

As shown in FIG. 18B, the node 447 is connected to an inductor-inductorresonant circuit 450 formed by inductor L_(s) 452 and inductor L_(m)454. The FET gate driving circuitry 445 is arranged to generate drivesignals at a drive frequency (f_(d)) that opens and crosses the FETswitches 443 at the resonant frequency of the parallel resonant circuit450. As a result of the resonant characteristic of the resonant circuit450, the square wave voltage at node 447 will cause a substantiallysinusoidal current at the drive frequency (f_(d)) to flow within theresonant circuit 450. As illustrated in FIG. 18B, the inductor L_(m) 454is the primary of a transformer 455, the secondary of which is formed byinductor L_(sec) 456. The inductor L_(sec) 456 of the transformer 455secondary is connected to an inductor-capacitor-capacitor parallelresonant circuit 457 formed by inductor L₂ 458, capacitor C₄ 460, andcapacitor C₂ 462. The transformer 455 up-converts the drive voltage(V_(d)) across the inductor L_(m) 454 to the voltage that is applied tothe output parallel resonant circuit 457. The load voltage (V_(L)) isoutput by the parallel resonant circuit 457 and is applied to the load(represented by the load resistance R_(load) 459 in FIG. 18B)corresponding to the impedance of the forceps' jaws and any tissue orvessel gripped by the end effector 326. As shown in FIG. 18B, a pair ofDC blocking capacitors C_(bl) 480-1 and 480-2 is provided to prevent anyDC signal being applied to the load 459.

In one embodiment, the transformer 455 may be implemented with a CoreDiameter (mm), Wire Diameter (mm), and Gap between secondary windings inaccordance with the following specifications:

Core Diameter, D (mm)

D=19.9×10−3

Wire diameter, W (mm) for 22 AWG wire

W=7.366×10−4

Gap between secondary windings, in gap=0.125

G=gap/25.4

In this embodiment, the amount of electrical power supplied to the endeffector 326 is controlled by varying the frequency of the switchingsignals used to switch the FETs 443. This works because the resonantcircuit 450 acts as a frequency dependent (loss less) attenuator. Thecloser the drive signal is to the resonant frequency of the resonantcircuit 450, the less the drive signal is attenuated. Similarly, as thefrequency of the drive signal is moved away from the resonant frequencyof the circuit 450, the more the drive signal is attenuated and so thepower supplied to the load reduces. In this embodiment, the frequency ofthe switching signals generated by the FET gate drive circuitry 445 iscontrolled by a controller 481 based on a desired power to be deliveredto the load 459 and measurements of the load voltage (V_(L)) and of theload current (I_(L)) obtained by conventional voltage sensing circuitry483 and current sensing circuitry 485. The way that the controller 481operates will be described in more detail below.

In one embodiment, the voltage sensing circuitry 483 and the currentsensing circuitry 485 may be implemented with high bandwidth, high speedrail-to-rail amplifiers (e.g., LMH6643 by National Semiconductor). Suchamplifiers, however, consume a relatively high current when they areoperational. Accordingly, a power save circuit may be provided to reducethe supply voltage of the amplifiers when they are not being used in thevoltage sensing circuitry 483 and the current sensing circuitry 485. Inone-embodiment, a step-down regulator (e.g., LT3502 by LinearTechnologies) may be employed by the power save circuit to reduce thesupply voltage of the rail-to-rail amplifiers and thus extend the lifeof the battery 437.

FIG. 18C illustrates the main components of the controller 481,according to one embodiment. In the embodiment illustrated in FIG. 18C,the controller 481 may comprise a processing unit such as amicroprocessor based controller and so most of the componentsillustrated in FIG. 16 are software based components. Nevertheless, ahardware based controller 481 may be used instead. As shown, thecontroller 481 includes synchronous I,Q sampling circuitry 491 thatreceives the sensed voltage and current signals from the sensingcircuitry 483 and 485 and obtains corresponding samples which are passedto a power, V_(rms) and I_(rms) calculation module 493. The calculationmodule 493 uses the received samples to calculate the RMS voltage andRMS current applied to the load 459 (FIG. 18B; end effector 326 andtissue/vessel gripped thereby) and from them the power that is presentlybeing supplied to the load 459. The determined values are then passed toa frequency control module 495 and a medical device control module 497.The medical device control module 497 uses the values to determine thepresent impedance of the load 459 and based on this determined impedanceand a pre-defined algorithm, determines what set point power (P_(set))should be applied to the frequency control module 495. The medicaldevice control module 497 is in turn controlled by signals received froma user input module 499 that receives inputs from the user (for examplepressing buttons or activating the control levers 114, 110 on the handle104) and also controls output devices (lights, a display, speaker or thelike) on the handle 104 via a user output module 461.

The frequency control module 495 uses the values obtained from thecalculation module 493 and the power set point (P_(set)) obtained fromthe medical device control module 497 and predefined system limits (tobe explained below), to determine whether or not to increase or decreasethe applied frequency. The result of this decision is then passed to asquare wave generation module 463 which, in this embodiment, incrementsor decrements the frequency of a square wave signal that it generates by1 kHz, depending on the received decision. As those skilled in the artwill appreciate, in an alternative embodiment, the frequency controlmodule 495 may determine not only whether to increase or decrease thefrequency, but also the amount of frequency change required. In thiscase, the square wave generation module 463 would generate thecorresponding square wave signal with the desired frequency shift. Inthis embodiment, the square wave signal generated by the square wavegeneration module 463 is output to the FET gate drive circuitry 445,which amplifies the signal and then applies it to the FET 443-1. The FETgate drive circuitry 445 also inverts the signal applied to the FET443-1 and applies the inverted signal to the FET 443-2.

The electrosurgical instrument 410 may comprise additional features asdiscussed with respect to electrosurgical system 300. Those skilled inthe art will recognize that electrosurgical instrument 410 may include arotation knob 348, an elongated shaft 314, and an end effector 326.These elements function in a substantially similar manner to thatdiscussed above with respect to the electrosurgical system 300. In oneexample embodiment, the cordless electrosurgical instrument 410 mayinclude visual indicators 435. The visual indicators 435 may provide avisual indication signal to an operator. In one example embodiment, thevisual indication signal may alert an operator that the device is on, orthat the device is applying energy to the end effector. Those skilled inthe art will recognize that the visual indicators 435 may be configuredto provide information on multiple states of the device.

Over the years a variety of minimally invasive robotic (or“telesurgical”) systems have been developed to increase surgicaldexterity as well as to permit a surgeon to operate on a patient in anintuitive manner. Robotic surgical systems can be used with manydifferent types of surgical instruments including, for example,ultrasonic or electrosurgical instruments, as described herein. Examplerobotic systems include those manufactured by Intuitive Surgical, Inc.,of Sunnyvale, Calif., U.S.A. Such systems, as well as robotic systemsfrom other manufacturers, are disclosed in the following U.S. patentswhich are each herein incorporated by reference in their respectiveentirety: U.S. Pat. No. 5,792,135, entitled “Articulated SurgicalInstrument For Performing Minimally Invasive Surgery With EnhancedDexterity and Sensitivity”, U.S. Pat. No. 6,231,565, entitled “RoboticArm DLUs For Performing Surgical Tasks”, U.S. Pat. No. 6,783,524,entitled “Robotic Surgical Tool With Ultrasound Cauterizing and CuttingInstrument”, U.S. Pat. No. 6,364,888, entitled “Alignment of Master andSlave In a Minimally Invasive Surgical Apparatus”, U.S. Pat. No.7,524,320, entitled “Mechanical Actuator Interface System For RoboticSurgical Tools”, U.S. Pat. No. 7,691,098, entitled Platform Link WristMechanism”, U.S. Pat. No. 7,806,891, entitled “Repositioning andReorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery”, and U.S. Pat. No. 7,824,401, entitled “Surgical Tool WithWrited Monopolar Electrosurgical End Effectors”. Many of such systems,however, have in the past been unable to generate the magnitude offorces required to effectively cut and fasten tissue.

FIGS. 19-46C illustrate example embodiments of robotic surgical systems.In some embodiments, the disclosed robotic surgical systems may utilizethe ultrasonic or electrosurgical instruments described herein. Thoseskilled in the art will appreciate that the illustrated robotic surgicalsystems are not limited to only those instruments described herein, andmay utilize any compatible surgical instruments. Those skilled in theart will further appreciate that while various embodiments describedherein may be used with the described robotic surgical systems, thedisclosure is not so limited, and may be used with any compatiblerobotic surgical system.

FIGS. 19-25 illustrate the structure and operation of several examplerobotic surgical systems and components thereof. FIG. 19 shows a blockdiagram of an example robotic surgical system 500. The system 500comprises at least one controller 508 and at least one arm cart 510. Thearm cart 510 may be mechanically coupled to one or more roboticmanipulators or arms, indicated by box 512. Each of the robotic arms 512may comprise one or more surgical instruments 514 for performing varioussurgical tasks on a patient 504. Operation of the arm cart 510,including the arms 512 and instruments 514 may be directed by aclinician 502 from a controller 508. In some embodiments, a secondcontroller 508′, operated by a second clinician 502′ may also directoperation of the arm cart 510 in conjunction with the first clinician502′. For example, each of the clinicians 502, 502′ may controldifferent arms 512 of the cart or, in some cases, complete control ofthe arm cart 510 may be passed between the clinicians 502, 502′. In someembodiments, additional arm carts (not shown) may be utilized on thepatient 504. These additional arm carts may be controlled by one or moreof the controllers 508, 508′. The arm cart(s) 510 and controllers 508,508′ may be in communication with one another via a communications link516, which may be any suitable type of wired or wireless communicationslink carrying any suitable type of signal (e.g., electrical, optical,infrared, etc.) according to any suitable communications protocol.Example implementations of robotic surgical systems, such as the system5000, are disclosed in U.S. Pat. No. 7,524,320 which has been hereinincorporated by reference. Thus, various details of such devices willnot be described in detail herein beyond that which may be necessary tounderstand various embodiments of the claimed device.

FIG. 20 shows one example embodiment of a robotic arm cart 520. Therobotic arm cart 520 is configured to actuate a plurality of surgicalinstruments or instruments, generally designated as 522 within a workenvelope 519. Various robotic surgery systems and methods employingmaster controller and robotic arm cart arrangements are disclosed inU.S. Pat. No. 6,132,368, entitled “Multi-Component Telepresence Systemand Method”, the full disclosure of which is incorporated herein byreference. In various forms, the robotic arm cart 520 includes a base524 from which, in the illustrated embodiment, three surgicalinstruments 522 are supported. In various forms, the surgicalinstruments 522 are each supported by a series of manually articulatablelinkages, generally referred to as set-up joints 526, and a roboticmanipulator 528. These structures are herein illustrated with protectivecovers extending over much of the robotic linkage. These protectivecovers may be optional, and may be limited in size or entirelyeliminated in some embodiments to minimize the inertia that isencountered by the servo mechanisms used to manipulate such devices, tolimit the volume of moving components so as to avoid collisions, and tolimit the overall weight of the cart 520. Cart 520 will generally havedimensions suitable for transporting the cart 520 between operatingrooms. The cart 520 may be configured to typically fit through standardoperating room doors and onto standard hospital elevators. In variousforms, the cart 520 would preferably have a weight and include a wheel(or other transportation) system that allows the cart 520 to bepositioned adjacent an operating table by a single attendant.

FIG. 21 shows one example embodiment of the robotic manipulator 528 ofthe robotic arm cart 520. In the example shown in FIG. 21, the roboticmanipulators 528 may include a linkage 530 that constrains movement ofthe surgical instrument 522. In various embodiments, linkage 530includes rigid links coupled together by rotational joints in aparallelogram arrangement so that the surgical instrument 522 rotatesaround a point in space 532, as more fully described in issued U.S. Pat.No. 5,817,084, the full disclosure of which is herein incorporated byreference. The parallelogram arrangement constrains rotation to pivotingabout an axis 534 a, sometimes called the pitch axis. The linkssupporting the parallelogram linkage are pivotally mounted to set-upjoints 526 (FIG. 20) so that the surgical instrument 522 further rotatesabout an axis 534 b, sometimes called the yaw axis. The pitch and yawaxes 534 a, 534 b intersect at the remote center 536, which is alignedalong a shaft 538 of the surgical instrument 522. The surgicalinstrument 522 may have further degrees of driven freedom as supportedby manipulator 540, including sliding motion of the surgical instrument522 along the longitudinal instrument axis “LT-LT”. As the surgicalinstrument 522 slides along the instrument axis LT-LT relative tomanipulator 540 (arrow 534 c), remote center 536 remains fixed relativeto base 542 of manipulator 540. Hence, the entire manipulator 540 isgenerally moved to re-position remote center 536. Linkage 530 ofmanipulator 540 is driven by a series of motors 544. These motors 544actively move linkage 530 in response to commands from a processing unitof a control system. As will be discussed in further detail below,motors 544 are also employed to manipulate the surgical instrument 522.

FIG. 22 shows one example embodiment of a robotic arm cart 520′ havingan alternative set-up joint structure. In this example embodiment, asurgical instrument 522 is supported by an alternative manipulatorstructure 528′ between two tissue manipulation instruments. Those ofordinary skill in the art will appreciate that various embodiments ofthe claimed device may incorporate a wide variety of alternative roboticstructures, including those described in U.S. Pat. No. 5,878,193, thefull disclosure of which is incorporated herein by reference.Additionally, while the data communication between a robotic componentand the processing unit of the robotic surgical system is primarilydescribed herein with reference to communication between the surgicalinstrument 522 and the controller, it should be understood that similarcommunication may take place between circuitry of a manipulator, aset-up joint, an endoscope or other image capture device, or the like,and the processing unit of the robotic surgical system for componentcompatibility verification, component-type identification, componentcalibration (such as off-set or the like) communication, confirmation ofcoupling of the component to the robotic surgical system, or the like.

FIG. 23 shows one example embodiment of a controller 518 that may beused in conjunction with a robotic arm cart, such as the robotic armcarts 520, 520′ depicted in FIGS. 20-22. The controller 518 generallyincludes master controllers (generally represented as 519 in FIG. 23)which are grasped by the clinician and manipulated in space while theclinician views the procedure via a stereo display 521. A surgeon feedback meter 515 may be viewed via the display 521 and provide the surgeonwith a visual indication of the amount of force being applied to thecutting instrument or dynamic clamping member. The master controllers519 generally comprise manual input devices which preferably move withmultiple degrees of freedom, and which often further have a handle ortrigger for actuating instruments (for example, for closing graspingsaws, applying an electrical potential to an electrode, or the like).

FIG. 24 shows one example embodiment of an ultrasonic surgicalinstrument 522 adapted for use with a robotic surgical system. Forexample, the surgical instrument 522 may be coupled to one of thesurgical manipulators 528, 528′ described hereinabove. As can be seen inFIG. 24, the surgical instrument 522 comprises a surgical end effector548 that comprises an ultrasonic blade 550 and clamp arm 552, which maybe coupled to an elongated shaft assembly 554 that, in some embodiments,may comprise an articulation joint 556. FIG. 25 shows another exampleembodiment having an electrosurgical instrument 523 in place of theultrasonic surgical instrument 522. The surgical instrument 523comprises a surgical end effector 548 that comprises closable jaws 551A,551B having energy deliver surfaces 553A, 553B for engaging andproviding electrical energy to tissue between the jaws 551A, 551B. Atissue cutting element or knife 555 may be positioned at the distal endof an axially movable member 557 that may extend through the elongatedshaft assembly 554 to the instrument mounting portion 558. FIG. 26 showsone example embodiment of an instrument drive assembly 546 that may becoupled to one of the surgical manipulators 528, 528′ to receive andcontrol the surgical instruments 522, 523. The instrument drive assembly546 may also be operatively coupled to the controller 518 to receiveinputs from the clinician for controlling the instrument 522, 523. Forexample, actuation (e.g., opening and closing) of the clamp arm 552,actuation (e.g., opening and closing) of the jaws 551A, 551B, actuationof the ultrasonic blade 550, extension of the knife 555 and actuation ofthe energy delivery surfaces 553A, 553B, etc. may be controlled throughthe instrument drive assembly 546 based on inputs from the clinicianprovided through the controller 518. The surgical instrument 522 isoperably coupled to the manipulator by an instrument mounting portion,generally designated as 558. The surgical instruments 522 furtherinclude an interface 560 which mechanically and electrically couples theinstrument mounting portion 558 to the manipulator.

FIG. 27 shows another view of the instrument drive assembly of FIG. 26including the ultrasonic surgical instrument 522. FIG. 28 shows anotherview of the instrument drive assembly of FIG. 26 including theelectrosurgical instrument 523. The instrument mounting portion 558includes an instrument mounting plate 562 that operably supports aplurality of (four are shown in FIG. 26) rotatable body portions, drivendiscs or elements 564, that each include a pair of pins 566 that extendfrom a surface of the driven element 564. One pin 566 is closer to anaxis of rotation of each driven elements 564 than the other pin 566 onthe same driven element 564, which helps to ensure positive angularalignment of the driven element 564. The driven elements 564 and pints566 may be positioned on an adapter side 567 of the instrument mountingplate 562.

Interface 560 also includes an adaptor portion 568 that is configured tomountingly engage the mounting plate 562 as will be further discussedbelow. The adaptor portion 568 may include an array of electricalconnecting pins 570, which may be coupled to a memory structure by acircuit board within the instrument mounting portion 558. Whileinterface 560 is described herein with reference to mechanical,electrical, and magnetic coupling elements, it should be understood thata wide variety of telemetry modalities might be used, includinginfrared, inductive coupling, or the like.

FIGS. 29-31 show additional views of the adapter portion 568 of theinstrument drive assembly 546 of FIG. 26. The adapter portion 568generally includes an instrument side 572 and a holder side 574 (FIG.29). In various embodiments, a plurality of rotatable bodies 576 aremounted to a floating plate 578 which has a limited range of movementrelative to the surrounding adaptor structure normal to the majorsurfaces of the adaptor 568. Axial movement of the floating plate 578helps decouple the rotatable bodies 576 from the instrument mountingportion 558 when the levers 580 along the sides of the instrumentmounting portion housing 582 are actuated (See FIGS. 24, 25) Othermechanisms/arrangements may be employed for releasably coupling theinstrument mounting portion 558 to the adaptor 568. In at least oneform, rotatable bodies 576 are resiliently mounted to floating plate 578by resilient radial members, which extend into a circumferentialindentation about the rotatable bodies 576. The rotatable bodies 576 canmove axially relative to plate 578 by deflection of these resilientstructures. When disposed in a first axial position (toward instrumentside 572) the rotatable bodies 576 are free to rotate without angularlimitation. However, as the rotatable bodies 576 move axially towardinstrument side 572, tabs 584 (extending radially from the rotatablebodies 576) laterally engage detents on the floating plates so as tolimit angular rotation of the rotatable bodies 576 about their axes.This limited rotation can be used to help drivingly engage the rotatablebodies 576 with drive pins 586 of a corresponding instrument holderportion 588 of the robotic system, as the drive pins 586 will push therotatable bodies 576 into the limited rotation position until the pins586 are aligned with (and slide into) openings 590.

Openings 590 on the instrument side 572 and openings 590 on the holderside 574 of rotatable bodies 576 are configured to accurately align thedriven elements 564 (FIGS. 27, 28) of the instrument mounting portion558 with the drive elements 592 of the instrument holder 588. Asdescribed above regarding inner and outer pins 566 of driven elements564, the openings 590 are at differing distances from the axis ofrotation on their respective rotatable bodies 576 so as to ensure thatthe alignment is not 33 degrees from its intended position.Additionally, each of the openings 590 may be slightly radiallyelongated so as to fittingly receive the pins 566 in the circumferentialorientation. This allows the pins 566 to slide radially within theopenings 590 and accommodate some axial misalignment between theinstrument 522, 523 and instrument holder 588, while minimizing anyangular misalignment and backlash between the drive and driven elements.Openings 590 on the instrument side 572 may be offset by about 90degrees from the openings 590 (shown in broken lines) on the holder side574, as can be seen most clearly in FIG. 31.

Various embodiments may further include an array of electrical connectorpins 570 located on holder side 574 of adaptor 568, and the instrumentside 572 of the adaptor 568 may include slots 594 (FIG. 31) forreceiving a pin array (not shown) from the instrument mounting portion558. In addition to transmitting electrical signals between the surgicalinstrument 522, 523 and the instrument holder 588, at least some ofthese electrical connections may be coupled to an adaptor memory device596 (FIG. 30) by a circuit board of the adaptor 568.

A detachable latch arrangement 598 may be employed to releasably affixthe adaptor 568 to the instrument holder 588. As used herein, the term“instrument drive assembly” when used in the context of the roboticsystem, at least encompasses various embodiments of the adapter 568 andinstrument holder 588 and which has been generally designated as 546 inFIG. 26. For example, as can be seen in FIG. 26, the instrument holder588 may include a first latch pin arrangement 600 that is sized to bereceived in corresponding clevis slots 602 provided in the adaptor 568.In addition, the instrument holder 588 may further have second latchpins 604 that are sized to be retained in corresponding latch clevises606 in the adaptor 568. See FIG. 30. In at least one form, a latchassembly 608 is movably supported on the adapter 568 and is biasablebetween a first latched position wherein the latch pins 600 are retainedwithin their respective latch clevis 606 and an unlatched positionwherein the second latch pins 604 may be into or removed from the latchclevises 606. A spring or springs (not shown) are employed to bias thelatch assembly into the latched position. A lip on the instrument side572 of adaptor 568 may slidably receive laterally extending tabs ofinstrument mounting housing 582.

As described the driven elements 564 may be aligned with the driveelements 592 of the instrument holder 588 such that rotational motion ofthe drive elements 592 causes corresponding rotational motion of thedriven elements 564. The rotation of the drive elements 592 and drivenelements 564 may be electronically controlled, for example, via therobotic arm 612, in response to instructions received from the clinician502 via a controller 508. The instrument mounting portion 558 maytranslate rotation of the driven elements 564 into motion of thesurgical instrument 522, 523.

FIGS. 32-34 show one example embodiment of the instrument mountingportion 558 showing components for translating motion of the drivenelements 564 into motion of the surgical instrument 522, 523. FIGS.32-34 show the instrument mounting portion with a shaft 538 having asurgical end effector 610 at a distal end thereof. The end effector 610may be any suitable type of end effector for performing a surgical taskon a patient. For example, the end effector may be configured to provideRF and/or ultrasonic energy to tissue at a surgical site. The shaft 538may be rotatably coupled to the instrument mounting portion 558 andsecured by a top shaft holder 646 and a bottom shaft holder 648 at acoupler 650 of the shaft 538.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for translating rotation of the various driven elements 564into rotation of the shaft 538, differential translation of membersalong the axis of the shaft (e.g., for articulation), and reciprocatingtranslation of one or more members along the axis of the shaft 538(e.g., for extending and retracting tissue cutting elements such as 555,overtubes and/or other components). In one example embodiment, therotatable bodies 612 (e.g., rotatable spools) are coupled to the drivenelements 564. The rotatable bodies 612 may be formed integrally with thedriven elements 564. In some embodiments, the rotatable bodies 612 maybe formed separately from the driven elements 564 provided that therotatable bodies 612 and the driven elements 564 are fixedly coupledsuch that driving the driven elements 564 causes rotation of therotatable bodies 612. Each of the rotatable bodies 612 is coupled to agear train or gear mechanism to provide shaft articulation and rotationand clamp jaw open/close and knife actuation.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for causing differential translation of two or more membersalong the axis of the shaft 538. In the example provided in FIGS. 32-34,this motion is used to manipulate articulation joint 556. In theillustrated embodiment, for example, the instrument mounting portion 558comprises a rack and pinion gearing mechanism to provide thedifferential translation and thus the shaft articulation functionality.In one example embodiment, the rack and pinion gearing mechanismcomprises a first pinion gear 614 coupled to a rotatable body 612 suchthat rotation of the corresponding driven element 564 causes the firstpinion gear 614 to rotate. A bearing 616 is coupled to the rotatablebody 612 and is provided between the driven element 564 and the firstpinion gear 614. The first pinion gear 614 is meshed to a first rackgear 618 to convert the rotational motion of the first pinion gear 614into linear motion of the first rack gear 618 to control thearticulation of the articulation section 556 of the shaft assembly 538in a left direction 620L. The first rack gear 618 is attached to a firstarticulation band 622 (FIG. 32) such that linear motion of the firstrack gear 618 in a distal direction causes the articulation section 556of the shaft assembly 538 to articulate in the left direction 620L. Asecond pinion gear 626 is coupled to another rotatable body 612 suchthat rotation of the corresponding driven element 564 causes the secondpinion gear 626 to rotate. A bearing 616 is coupled to the rotatablebody 612 and is provided between the driven element 564 and the secondpinion gear 626. The second pinion gear 626 is meshed to a second rackgear 628 to convert the rotational motion of the second pinion gear 626into linear motion of the second rack gear 628 to control thearticulation of the articulation section 556 in a right direction 620R.The second rack gear 628 is attached to a second articulation band 624(FIG. 33) such that linear motion of the second rack gear 628 in adistal direction causes the articulation section 556 of the shaftassembly 538 to articulate in the right direction 620R. Additionalbearings may be provided between the rotatable bodies and thecorresponding gears. Any suitable bearings may be provided to supportand stabilize the mounting and reduce rotary friction of shaft andgears, for example.

In one example embodiment, the instrument mounting portion 558 furthercomprises a mechanism for translating rotation of the driven elements564 into rotational motion about the axis of the shaft 538. For example,the rotational motion may be rotation of the shaft 538 itself. In theillustrated embodiment, a first spiral worm gear 630 coupled to arotatable body 612 and a second spiral worm gear 632 coupled to theshaft assembly 538. A bearing 616 (FIG. 17) is coupled to a rotatablebody 612 and is provided between a driven element 564 and the firstspiral worm gear 630. The first spiral worm gear 630 is meshed to thesecond spiral worm gear 632, which may be coupled to the shaft assembly538 and/or to another component of the instrument 522, 523 for whichlongitudinal rotation is desired. Rotation may be caused in a clockwise(CW) and counter-clockwise (CCW) direction based on the rotationaldirection of the first and second spiral worm gears 630, 632.Accordingly, rotation of the first spiral worm gear 630 about a firstaxis is converted to rotation of the second spiral worm gear 632 about asecond axis, which is orthogonal to the first axis. As shown in FIGS.32-33, for example, a CW rotation of the second spiral worm gear 632results in a CW rotation of the shaft assembly 538 in the directionindicated by 634CW. A CCW rotation of the second spiral worm gear 632results in a CCW rotation of the shaft assembly 538 in the directionindicated by 634CCW. Additional bearings may be provided between therotatable bodies and the corresponding gears. Any suitable bearings maybe provided to support and stabilize the mounting and reduce rotaryfriction of shaft and gears, for example.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for generating reciprocating translation of one or moremembers along the axis of the shaft 538. Such translation may be used,for example to drive a tissue cutting element, such as 555, drive anovertube for closure and/or articulation of the end effector 610, etc.In the illustrated embodiment, for example, a rack and pinion gearingmechanism may provide the reciprocating translation. A first gear 636 iscoupled to a rotatable body 612 such that rotation of the correspondingdriven element 564 causes the first gear 636 to rotate in a firstdirection. A second gear 638 is free to rotate about a post 640 formedin the instrument mounting plate 562. The first gear 636 is meshed tothe second gear 638 such that the second gear 638 rotates in a directionthat is opposite of the first gear 636. In one example embodiment, thesecond gear 638 is a pinion gear meshed to a rack gear 642, which movesin a liner direction. The rack gear 642 is coupled to a translatingblock 644, which may translate distally and proximally with the rackgear 642. The translation block 644 may be coupled to any suitablecomponent of the shaft assembly 538 and/or the end effector 610 so as toprovide reciprocating longitudinal motion. For example, the translationblock 644 may be mechanically coupled to the tissue cutting element 555of the RF surgical device 523. In some embodiments, the translationblock 644 may be coupled to an overtube, or other component of the endeffector 610 or shaft 538.

FIGS. 35-37 illustrate an alternate embodiment of the instrumentmounting portion 558 showing an alternate example mechanism fortranslating rotation of the driven elements 564 into rotational motionabout the axis of the shaft 538 and an alternate example mechanism forgenerating reciprocating translation of one or more members along theaxis of the shaft 538. Referring now to the alternate rotationalmechanism, a first spiral worm gear 652 is coupled to a second spiralworm gear 654, which is coupled to a third spiral worm gear 656. Such anarrangement may be provided for various reasons including maintainingcompatibility with existing robotic systems 1000 and/or where space maybe limited. The first spiral worm gear 652 is coupled to a rotatablebody 612. The third spiral worm gear 656 is meshed with a fourth spiralworm gear 658 coupled to the shaft assembly 538. A bearing 760 iscoupled to a rotatable body 612 and is provided between a driven element564 and the first spiral worm gear 738. Another bearing 760 is coupledto a rotatable body 612 and is provided between a driven element 564 andthe third spiral worm gear 652. The third spiral worm gear 652 is meshedto the fourth spiral worm gear 658, which may be coupled to the shaftassembly 538 and/or to another component of the instrument 522, 523 forwhich longitudinal rotation is desired. Rotation may be caused in a CWand a CCW direction based on the rotational direction of the spiral wormgears 656, 658. Accordingly, rotation of the third spiral worm gear 656about a first axis is converted to rotation of the fourth spiral wormgear 658 about a second axis, which is orthogonal to the first axis. Asshown in FIGS. 36 and 37, for example, the fourth spiral worm gear 658is coupled to the shaft 538, and a CW rotation of the fourth spiral wormgear 658 results in a CW rotation of the shaft assembly 538 in thedirection indicated by 634CW. A CCW rotation of the fourth spiral wormgear 658 results in a CCW rotation of the shaft assembly 538 in thedirection indicated by 634CCW. Additional bearings may be providedbetween the rotatable bodies and the corresponding gears. Any suitablebearings may be provided to support and stabilize the mounting andreduce rotary friction of shaft and gears, for example.

Referring now to the alternate example mechanism for generatingreciprocating translation of one or more members along the axis of theshaft 538, the instrument mounting portion 558 comprises a rack andpinion gearing mechanism to provide reciprocating translation along theaxis of the shaft 538 (e.g., translation of a tissue cutting element 555of the RF surgical device 523). In one example embodiment, a thirdpinion gear 660 is coupled to a rotatable body 612 such that rotation ofthe corresponding driven element 564 causes the third pinion gear 660 torotate in a first direction. The third pinion gear 660 is meshed to arack gear 662, which moves in a linear direction. The rack gear 662 iscoupled to a translating block 664. The translating block 664 may becoupled to a component of the device 522, 523, such as, for example, thetissue cutting element 555 of the RF surgical device and/or an overtubeor other component which is desired to be translated longitudinally.

FIGS. 38-42 illustrate an alternate embodiment of the instrumentmounting portion 558 showing another alternate example mechanism fortranslating rotation of the driven elements 564 into rotational motionabout the axis of the shaft 538. In FIGS. 38-42, the shaft 538 iscoupled to the remainder of the mounting portion 558 via a coupler 676and a bushing 678. A first gear 666 coupled to a rotatable body 612, afixed post 668 comprising first and second openings 672, first andsecond rotatable pins 674 coupled to the shaft assembly, and a cable 670(or rope). The cable is wrapped around the rotatable body 612. One endof the cable 670 is located through a top opening 672 of the fixed post668 and fixedly coupled to a top rotatable pin 674. Another end of thecable 670 is located through a bottom opening 672 of the fixed post 668and fixedly coupled to a bottom rotating pin 674. Such an arrangement isprovided for various reasons including maintaining compatibility withexisting robotic systems 1000 and/or where space may be limited.Accordingly, rotation of the rotatable body 612 causes the rotationabout the shaft assembly 538 in a CW and a CCW direction based on therotational direction of the rotatable body 612 (e.g., rotation of theshaft 538 itself). Accordingly, rotation of the rotatable body 612 abouta first axis is converted to rotation of the shaft assembly 538 about asecond axis, which is orthogonal to the first axis. As shown in FIGS.38-39, for example, a CW rotation of the rotatable body 612 results in aCW rotation of the shaft assembly 538 in the direction indicated by634CW. A CCW rotation of the rotatable body 612 results in a CCWrotation of the shaft assembly 538 in the direction indicated by 634CCW.Additional bearings may be provided between the rotatable bodies and thecorresponding gears. Any suitable bearings may be provided to supportand stabilize the mounting and reduce rotary friction of shaft andgears, for example.

FIGS. 43-46A illustrate an alternate embodiment of the instrumentmounting portion 558 showing an alternate example mechanism fordifferential translation of members along the axis of the shaft 538(e.g., for articulation). For example, as illustrated in FIGS. 43-46A,the instrument mounting portion 558 comprises a double cam mechanism 680to provide the shaft articulation functionality. In one exampleembodiment, the double cam mechanism 680 comprises first and second camportions 680A, 680B. First and second follower arms 682, 684 arepivotally coupled to corresponding pivot spools 686. As the rotatablebody 612 coupled to the double cam mechanism 680 rotates, the first camportion 680A acts on the first follower arm 682 and the second camportion 680B acts on the second follower arm 684. As the cam mechanism680 rotates the follower arms 682, 684 pivot about the pivot spools 686.The first follower arm 682 may be attached to a first member that is tobe differentially translated (e.g., the first articulation band 622).The second follower arm 684 is attached to a second member that is to bedifferentially translated (e.g., the second articulation band 624). Asthe top cam portion 680A acts on the first follower arm 682, the firstand second members are differentially translated. In the exampleembodiment where the first and second members are the respectivearticulation bands 622 and 624, the shaft assembly 538 articulates in aleft direction 620L. As the bottom cam portion 680B acts of the secondfollower arm 684, the shaft assembly 538 articulates in a rightdirection 620R. In some example embodiments, two separate bushings 688,690 are mounted beneath the respective first and second follower arms682, 684 to allow the rotation of the shaft without affecting thearticulating positions of the first and second follower arms 682, 684.For articulation motion, these bushings reciprocate with the first andsecond follower arms 682, 684 without affecting the rotary position ofthe jaw 902. FIG. 46A shows the bushings 688, 690 and the dual camassembly 680, including the first and second cam portions 680B, 680B,with the first and second follower arms 682, 684 removed to provide amore detailed and clearer view.

In various embodiments, the instrument mounting portion 558 mayadditionally comprise internal energy sources for driving electronicsand provided desired ultrasonic and/or RF frequency signals to surgicaltools. FIGS. 46B-46C illustrate one embodiment of an instrument mountingportion 558′ comprising internal power and energy sources. For example,surgical instruments (e.g., instruments 522, 523) mounted utilizing theinstrument mounting portion 558′ need not be wired to an externalgenerator or other power source. Instead, the functionality of thevarious generators 20, 320 described herein may be implemented on boardthe mounting portion 558.

As illustrated in FIGS. 46B-46C, the instrument mounting portion 558′may comprise a distal portion 702. The distal portion 702 may comprisevarious mechanisms for coupling rotation of drive elements 612 to endeffectors of the various surgical instruments 522, 523, for example, asdescribed herein above. Proximal of the distal portion 702, theinstrument mounting portion 558′ comprises an internal direct current(DC) energy source and an internal drive and control circuit 704. In theillustrated embodiment, the energy source comprises a first and secondbattery 706, 708. In other respects, the instrument mounting portion558′ is similar to the various embodiments of the instrument mountingportion 558 described herein above.

The control circuit 704 may operate in a manner similar to thatdescribed above with respect to generators 20, 320. For example, when anultrasonic instrument 522 is utilized, the control circuit 704 mayprovide an ultrasonic drive signal in a manner similar to that describedabove with respect to generator 20. Also, for example, when an RFinstrument 523 or ultrasonic instrument 522 capable of providing atherapeutic or non-therapeutic RF signal is used, the control circuit704 may provide an RF drive signal, for example, as described hereinabove with respect to the module 23 of generator 20 and/or the generator300. In some embodiments, the control circuit 704 may be configured in amanner similar to that of the control circuit 440 described herein abovewith respect to FIGS. 18B-18C.

Various embodiments of an ultrasonic surgical instrument comprising anarticulable harmonic waveguide are discussed below. It will beappreciated by those skilled in the art that the terms “proximal” anddistal,” as used in reference to the ultrasonic surgical instrument, aredefined relative to a clinician gripping the handpiece of theinstrument. Thus, movement in the distal direction would be movement ina direction away from the clinician. It will be further appreciatedthat, for convenience and clarity, special terms such as “top” and“bottom” are also used herein with respect to the clinician gripping thehandpiece assembly. However, the ultrasonic surgical instrument may beused in many orientations and positions, and these terms are notintended to be limiting or absolute.

The various embodiments will be described in combination with therobotic surgical system 500 described above and ultrasonic surgicalinstrument 10 described above. Such description is provided by way ofexample and not limitation, and is not intended to limit the scope andapplications thereof. For example, as will be appreciated by one skilledin the art, any one of the described articulable harmonic waveguides maybe useful in combination with a multitude of robotic or handheldsurgical systems.

FIGS. 47 and 48A-C illustrate one embodiment of an articulable harmonicwaveguide 802. The articulable harmonic waveguide 802 may comprise adriving section 804, a flexible waveguide 806, and an end effector 808.The articulating function of the articulable harmonic waveguide 802 maybe accomplished through the flexible waveguide 806.

In one embodiment, the articulable harmonic waveguide 802 may comprise adriving section 804. The driving section 804 may extend proximally toprovide a connection for the articulable harmonic waveguide to anultrasonic transducer (not shown), such as, for example, a piezoelectricor magnetorestrictive transducer. The driving section 804 may comprise astiff section. In some embodiments, the drive section 804 may compriseone or more cross-sectional area changes. The cross-sectional areachanges may correspond to an associated gain in an ultrasonic wavetraveling through the drive section 804.

In one embodiment, a flexible waveguide 806 may connect the drivingsection 804 and the end effector 808. The flexible waveguide 806 mayallow the end effector 808 to be bent at an angle to a longitudinal axis814 of the drive section 804. In one embodiment, the flexible waveguide806 may have equal bending stiffness in all planes intersecting thelongitudinal axis 814 of the drive section 804. In other embodiments,the flexible waveguide 806 may be biased in one or more planes, such as,for example, having a low bending stiffness in a first plane and a highbending stiffness in all other planes.

In one embodiment, the flexible waveguide 806 may comprise a circularcross-section. In another embodiment, the flexible waveguide 806 maycomprise a non-circular cross-section, such as, for example, a ribbon.The cross-section of the flexible waveguide 806 may be chosen tomaximize the differential in frequency between the resonance andanti-resonance frequencies of the acoustic system. In one embodiment,the flexible waveguide 806 may comprise one or more sections ofdifferent cross-sectional geometry. In this embodiment, the junctionbetween the one or more sections of different cross-sectional geometrymay be located at a node, an antinode, or in between a node and anantinode.

In one embodiment, the articulable harmonic waveguide 802 may comprisean end effector 808. The end effector 808 located distally to theflexible waveguide 806. The end effector 808 may comprise a stiffsection. In one embodiment, the end effector 808 may comprise a solidpiece. In another embodiment, the end effector 808 may be hollow. Thehollow end effector may be filled with a material to increase radialstiffness. In some embodiments, the end effector 808 may be straight,curved, or any combination thereof. In another embodiment, thearticulable harmonic waveguide 802 may lack a discrete end effector 808.In this embodiment, the function of the end effector 808 may beperformed by the distal end of the flexible waveguide 806. In someembodiments, the end effector 808 may comprise a ceramic or othercoating to modify the surface behavior of the end effector 808 when theend effector 808 comes in contact with other materials.

In one embodiment, a junction 810 between the driving section 804 andthe flexible waveguide 806 is located at a first predetermined locationand a junction 812 between the flexible waveguide 806 and the endeffector 808 is located at a second predetermined location. In someembodiments, the first and second predetermined locations may be thelocations of a node, an antinode, or some intermediate location. Inanother embodiment, the predetermined locations may be positioned suchthat a center point of the flexible waveguide is located at a node, anantinode, or some intermediate location. The respective lengths of thedriving section 804, the flexible waveguide 806, and the end effector808 may be determined relative to an acoustic, longitudinal mode shape.In another embodiment, the respective lengths of the driving section804, the flexible waveguide 806, and the end effector 808 may bedetermined may be determined relative to a torsional mode shape, atransverse mode shape, or some combination thereof. In one embodiment,the length of the flexible waveguide 806 may be dependent upon a phasevelocity increase of an ultrasonic wave due to the curvature of thearticulable harmonic waveguide 802.

In one embodiment, the flexible portion 806 may have a length equal tosome multiple of half wavelengths. For example, in one embodiment, theflexible waveguide 806 may have a length of 2 half wavelengths, or onewavelength. In another embodiment, the flexible waveguide 806 may have alength equal to three half wavelengths. Those skilled in the art willrecognize that the length of the flexible waveguide 806 may comprise anysuitable multiple of half wavelengths.

In one embodiment, the articulable harmonic waveguide 802 may comprise asingle piece. In another embodiment, the drive section 804, the flexiblewaveguide 806, and the end effector 808 may be individually manufacturedand joined together by any suitable technique, such as, for example,threaded fastenings, brazing, press-fitting, adhesives, laser welding,diffusion bonding, or any combination thereof.

In one embodiment, the articulable harmonic waveguide 802 may comprise aflexible waveguide 806 comprising a radius of curvature configured toreduce the effect of flexural waves (both transmitted and reflected).The local curvature of the flexible waveguide section 806 may result inflexural waves. Flexural waves may be transmitted, reflected, or bothand may deform a structure, such as, for example, the flexible waveguide806, as they propagate through the structure. In one embodiment, thearticulable harmonic waveguide is configured to reduce flexural waves.To ensure that for an extensional (longitudinal) wave, the effect offlexural waves due to the local curvature is small, the flexiblewaveguide 806 may be configured to satisfy a radius of curvatureequation:

$\frac{r}{R} < 0.1$

where ‘r’ is the radius of the articulable harmonic waveguide 802 and Ris the local radius of curvature, e.g., the radius of curvature of theflexible waveguide 806 with respect to the longitudinal axis of thedrive section.

In one embodiment, the articulable harmonic waveguide 802 may comprise atotal curvature limiter to prevent the flexible waveguide 806 fromapproaching the cut-off frequency of the articulable harmonic waveguide802. A cut-off frequency is a boundary at which point the energy passingthrough a system, for example, the articulable harmonic waveguide 802,begins to be reduced rather than pass through. In one embodiment, thelocal radius of curvature, R, of the flexible waveguide 806 is limitedsuch that:

$R = \frac{c}{2{\pi \cdot f}}$

where c is the bar speed of sound of the material comprising theflexible waveguide 806 and f is the drive frequency delivered to thearticulable harmonic waveguide 802 by an ultrasonic transducer.

In one embodiment, it may be desirable to minimize the transverse motionof the driving section 804 for a specific acoustic (longitudinal) mode.In one embodiment, the transverse motion of the driving section 804 maybe reduced by choosing a length for the driving section 804 which placesthe junction 810 between the driving section 804 and the flexiblewaveguide 806 at a node or anti-node and the junction 812 between theflexible waveguide 806 and the end effector 808 at a node or anti-node.For a ½λ standing wave within the flexible waveguide 806, therelationship between the subtended angle and the radius of curvature is:

$R = {c*\pi \frac{c \cdot \pi}{2 \cdot \theta \cdot {f_{0}( {\pi^{2} - \theta^{2}} )}}}$

where R is the radius of curvature, θ is the subtended angle, c is thebar phase velocity, and f₀ is the mode frequency. In one embodiment, toreduce or prevent permanent deformation (yielding), the flexiblewaveguide 806 may comprise a flexural strength less than the elasticlimit of section material.

FIGS. 48A-48C illustrate one embodiment of an articulable harmonicwaveguide 902 comprising a flexible waveguide 906. The flexiblewaveguide 906 has a ribbon-like cross-sectional area which results in aflex bias in direction A. FIG. 48A shows a top-down view of thearticulable harmonic waveguide 802. FIGS. 48B and 48C show a side viewof the articulable harmonic waveguide 902. FIGS. 48A and 48B illustratethe ribbon-like flexible waveguide 906 in an un-flexed, or straight,state. The ribbon-like flexible waveguide 906 has a flex bias indirection A (see FIG. 48B). The flexible waveguide 906 may be flexed indirection A to cause the end effector 908 to actuate at an angle to thelongitudinal axis 814 of the articulable harmonic waveguide 902. FIG.48C shows the articulable harmonic waveguide 902 in a flexed state.

In another embodiment, the flexible waveguide 906 may be semi-flexible.In this embodiment, the flexible waveguide 906 may be bent at an angleto the longitudinal axis of the articulable harmonic waveguide 902 andmay retain the bent configuration at or near the angle of flex from thelongitudinal axis.

FIGS. 49-51 illustrate various embodiments of an articulable harmonicwaveguide 802. FIG. 49 illustrates one embodiment of an articulableharmonic waveguide 1002 comprising a ribbon flexible waveguide 1006 anda hollow end effector 1008. The hollow end effector 1008 has a tissuetreatment section 1010 and a wave amplification section 1012. In someembodiments, the hollow end effector 1008 may be filled with a materialto increase radial stiffness.

FIG. 50 illustrates one embodiment of an articulable harmonic waveguide1102 comprising a circular flexible waveguide 1106 and a solid endeffector 1108. The circular flexible waveguide 1106 comprises an equalflex bias in all directions. FIG. 51 illustrates one embodiment of anarticulable harmonic waveguide 1202 comprising a ribbon flexiblewaveguide 1206 with one or more slots 1214 and a solid end effector1208. The solid end effector 1208 comprises a tissue treatment section1210 and a wave amplification section 1212.

FIGS. 52A and 52B illustrate one embodiment of an articulable harmonicwaveguide 1302 comprising first and second flexible waveguides 1306A,1306B. A first drive section 1304A extends proximally and may beconfigured to couple to an ultrasonic transducer in a handheld orrobotic surgical instrument. A second drive section connects the firstflexible waveguide 1306A with the second flexible waveguide 1306B. Thefirst and second flexible waveguides, 1360A, 1306B allow the articulableharmonic waveguide 802 to articulate in a first plane and second plane.In one embodiment, the first and second planes may be the same plane. Inthe embodiment shown in FIGS. 52A and 52B, the first and second planesare perpendicular. FIG. 52B shows the articulable harmonic waveguide1302 articulated in direction A. The articulable harmonic waveguide 1302may be further articulated by flexing the second flexible waveguide1306B in the plane extending into or out of the page.

FIGS. 53A and 53B illustrate another embodiment of articulable harmonicwaveguides 2202A, 2202B. The articulable harmonic waveguides 2202A,2202B comprise first drive sections 2204A, 2204B that extends proximallyand may be configured to couple to an ultrasonic transducer. Firstflexible waveguides 2206A, 2206B are coupled to the first drive sections2204A, 2204B. The first flexible waveguides 2206A, 2206B allow thearticulable harmonic waveguides 2202A, 2202B to articulate in a firstplane relative to the longitudinal axis 814. The articulable harmonicwaveguides 2202A, 2202B further comprise end effectors 2208A, 2208B. Theend effectors 2208A, 2208B comprise a tissue treatment section 2210A,2210B and a wave amplification section 2012A, 2012B. FIG. 53Billustrates a close-up view of the first flexible waveguides 2206A,2206B. The first flexible waveguides 2206A, 2206B comprise a ribbon-likesection with a low flex bias in a first direction and a high flex biasin all other directions. FIG. 54 illustrates the articulable harmonicwaveguide 2202A in a flexed position. The flexible waveguide 2206A isflexed at an angle to the longitudinal axis 814.

In one embodiment, the articulable harmonic waveguide 802 may comprisean articulation actuator to allow a user to flex the flexible waveguide806 at an angle with respect to the longitudinal axis 814 of the drivesection 804. The articulation actuator may comprise one or more controlmembers. FIGS. 53A and 53B illustrate one embodiment of an articulableharmonic waveguide 1402 comprising an articulation actuator 1416. Thearticulation actuator 1416 allows a user to actuate the articulableharmonic waveguide 1402 into a desired position or configuration. FIG.55A illustrates the articulable harmonic waveguide 1402 in an un-flexed,or mechanical ground, position. The articulation actuator 1416 comprisesa first nodal flange 1418A and a second nodal flange 1418B. The nodalflanges 1418A, 1418B may be located at nodes or anti-nodes of thearticulable harmonic waveguide 1402. In one embodiment, the second nodalflange 1418B is located at a distal most node or anti-node. In oneembodiment, the first and second nodal flanges 1418A, 1418B may belocated at the junctions between the drive section 1404, the flexiblewaveguide 1406, and the end effector 1408. A control member, such as,for example, a cable 1420, extends from second nodal flange 1418B in aproximal direction. The cable 1420 passes through a cable retainer (notshown) in the first nodal flange 1418A and continues proximally. Thecable 1420 may be actuated to flex the flexible section 1406. The cable1420 may be connected to a robotic surgical system, such as, forexample, robotic surgical system 500, a handheld surgical instrument,such as, for example, ultrasonic surgical instrument 10, or may extendproximally to allow a user to manipulate the cable directly.

FIG. 55B illustrates the articulable harmonic waveguide 1402 in a flexedstate. In this embodiment, the cable 1420 has been tensioned in aproximal direction, causing the flexible waveguide 1406 to flex withrespect to the longitudinal axis 814 of the articulable harmonicwaveguide 1402. The cable 1420 allows the flexible waveguide 1406 toflex in a specific direction relative to the longitudinal axis 814 ofthe articulable harmonic waveguide 1402. In one embodiment, thedirection of flex of the cable 1420 corresponds to the biased directionof flex of the flexible waveguide 1406.

FIG. 56 illustrates one embodiment of an articulable harmonic waveguide1502 comprising a two-cable articulation actuator 1516. The two-cablearticulation actuator 1516 comprises a first nodal flange 1518A, asecond nodal flange 1518B, and first and second control member, such as,for example, first and second cables 1520A, 1520B. The first and secondcables 1520A, 1520B may be diametrically opposed and may be permanentlyfixed to the second nodal flange 1518B. The first and second cables1520A, 1520B may extend proximally from the second nodal flange 1518B,pass through cable retainers in the first nodal flange 1518A andcontinue in a proximal direction. In one embodiment, the cable retainersmay comprise one or more holes formed in the first nodal flange 1518A.The first and second cables 1520A, 1520B may be connected to a roboticsurgical system, such as, for example, robotic surgical system 500, ahandheld surgical instrument, such as, for example, ultrasonic surgicalinstrument 10, or may extend proximally to allow a user to manipulatethe cable directly.

In the embodiment illustrated in FIG. 56, the flexible waveguide 1506may be flexed in a first direction ‘A’ or a second direction ‘B.’ Theflexible waveguide 1506 may be flexed in a first direction ‘A’ bytensioning the first cable 1520A in a proximal direction. When the firstcable 1520A is tensioned to cause the flexible waveguide 1506 to flex inthe first direction ‘A’, the second cable 1520B may be loosened to allowthe flexible waveguide 1506 to flex in the first direction ‘A’. Theflexible waveguide 1506 may be flexed in a second direction ‘B’ bytensioning the second cable 1520B in a proximal direction. When thesecond cable 1520B is tensioned, the first cable 1520A may be loosenedto allow the flexible waveguide 1306 to flex in the second direction‘B’. In one embodiment, a mechanism may be used to simultaneouslytighten the first cable 1520A and loosen the second cable 1520B, or tosimultaneously tighten the second cable 1520B and loosen the first cable1520A. In one embodiment, one or more spools may be used to allow onecable to be wrapped while the other cable is simultaneously loosened.

In one embodiment, the one or more control members may comprise a thincolumn connecting the first and second nodal flanges 1418A, 1418B. Thethin column may be “buckled” in one direction when the flanges are in analigned, or straight, position. The thin column may be pushed to“snap-through” to the side of the articulable harmonic waveguide 1402,causing the thin column to flex, the first and second nodal flanges1418A, 1418B to become misaligned, and the flexible waveguide 1406 toflex with respect to the longitudinal axis 814. In another embodiment,the first and second cables 1520A, 1520B may be replaced with bimetallicstrips that may be manipulated to misalign the flanges and flex theflexible waveguide 1406.

In one embodiment, the articulation actuator 1416 may comprise ajack-screw mechanism. The jack-screw mechanism may be coupled to thefirst and second nodal flanges, 1418A, 1418B. The jack-screw mechanismmay be actuated to push the first nodal flanges 1418A away from thesecond nodal flange 1418B. By forcing the first and second nodal flanges1418A, 1418B apart, the jack-screw mechanism causes the flexiblewaveguide 1406 to flex with respect to the longitudinal axis 814.

In one embodiment, the articulation actuator may comprise an articulableouter sheath disposed over the articulable harmonic waveguide 802. Inthis embodiment, the articulating harmonic waveguide 802 may compriseone or more intervening members, such as, for example, silicone fenders.The one or more intervening members may be disposed along thearticulating harmonic waveguide 802 to provide contact points betweenthe articulable harmonic waveguide 802 and the articulable outer sheath.In one embodiment, the one or more intervening members may act asflanges to allow articulation of the articulable harmonic waveguide 802.Examples of articulable outer sheaths which may be used as anarticulation actuator are disclosed in U.S. application Ser. No.13/538,588, entitled “Surgical Instruments with Articulating Shafts,”incorporated by reference herein. In various embodiments, theintervening members may be located at a node, an antinode, anintermediate point, or any combination thereof.

FIGS. 55-58 illustrate various embodiments of articulable harmonicwaveguides 1602, 1702, 1802, 1902 comprising a total curvature limiter.The total curvature limiter may comprise a mechanical or electricalbreak to prevent the articulable harmonic waveguide 802 from exceedingone or more predetermined conditions, such as, for example, ensuringthat the total curvature of the articulable harmonic waveguide 802 doesnot exceed limitations for efficient acoustic transmission. In oneembodiment, the flexible waveguide 806 is a small diameter or smalllateral dimension rod. The flexible waveguide 806 may be a relativelyshort section of the articulable harmonic waveguide 802. For example,the flexible waveguide 806 may be between 0.5-10 centimeters long. Theflexible waveguide 806 allows acoustic propagation around a bend orcorner.

The total curvature limiter may operate to prevent the articulableharmonic waveguide 802 from exceeding one or more predeterminedconstraints. In one embodiment, the one or more predeterminedconstraints may comprise acoustic transmission constraints. In a curvedwaveguide, such as, for example, the articulable harmonic waveguide 802in a flexed state, the curvature results in a resonant frequency shift.The resonant frequency shift may result in the drive frequency deliveredby the ultrasonic transducer to approach the cut-off frequency of thewaveguide. For conditions of slight local curvature and where the localcut-off conditions are not obtained, efficient transmission of motionthrough the waveguide depends on the mean-square curvature of thewaveguide. This relationship results in two conditions that mayconstrain the curvature of the articulable harmonic waveguide.

In one embodiment, the articulable harmonic waveguide 802 may comprise aflexible waveguide 806 comprising a radius of curvature configured toreduce the effect of flexural waves (both transmitted and reflected).The local curvature of the flexible waveguide section 806 may result inflexural waves. Flexural waves may be transmitted, reflected, or bothand may deform a structure, such as, for example, the flexible waveguide806, as they propagate through the structure. In one embodiment, thearticulable harmonic waveguide is configured to reduce flexural waves bymeeting a first condition. To ensure that for an extensional(longitudinal) wave, the effect of flexural waves due to the localcurvature is small, the flexible waveguide 806 may be configured tosatisfy the first condition requiring:

$\frac{r}{R} < 0.1$

where ‘r’ is the radius of the articulable harmonic waveguide 802 and Ris the local radius of curvature, e.g., the radius of curvature of theflexible waveguide 806 with respect to the longitudinal axis of thedrive section.

In one embodiment, a second condition may limit the radius of curvatureof the flexible waveguide 806 to prevent the articulable harmonicwaveguide 802 from approaching the cut-off frequency. A cut-offfrequency is a boundary at which point the energy passing through asystem, for example, the articulable harmonic waveguide 802, begins tobe reduced rather than passing through. In one embodiment, the localradius of curvature of the flexible waveguide 806 may be configured tosatisfy the second condition, requiring:

$R = \frac{c}{2{\pi \cdot f}}$

where R is the local radius of curvature, c is the bar speed of sound ofthe material comprising the flexible waveguide 806, and f is the drivefrequency delivered to the articulable harmonic waveguide 802 by anultrasonic transducer.

In another embodiment, the one or more predetermined constraints maycomprise a bending stress constraint. Bending stress can be approximatedfor a section of uniformly bent wire. In one embodiment, the bendingstress of the flexible waveguide 806 may be maintained at a value lessthan the material yield strength of the flexible waveguide 806. For aflexible waveguide 806 made from a material with modulus of elasticityE, the bending stress may be maintained according to a third constraint,requiring:

${{Bending}\mspace{14mu} {Stress}} = {{\frac{8}{\pi^{2}} \cdot \frac{E \cdot r}{R}} < {{Material}\mspace{14mu} {Yield}\mspace{14mu} {Strength}}}$

In another embodiment, the one or more predetermined constraints maycomprise access constraints. Constraints surrounding access to desiredtissue targets may be related to the anatomy of the site or theaccessory devices that provide the pathway from outside the body to ornear the target. This pathway may include, for example, trocars,flexible endoscopes, rigid laparoscopes, etc. For example, in oneembodiment, a flexible endoscope may encounter an approximately 2.75inch radius of curvatures as it passes through a patient's mouth andpharynx. As another example, the ETS-Flex 35 mm laparoscopic linearcutter available from Ethicon Endosurgery, Inc. provides access totarget structures by way of an articulating joint with a radius ofcurvature approximately 1.13 inches. As a third example, a distalretroflexing portion of a gastroscope may provide an accessory channelin a tight loop with a radius of about 1.1 inches.

In various embodiments, the one or more predetermined constraints maycomprise additional constraints, such as, for example, the resonantfrequency of the articulable harmonic waveguide 802, thepeak-displacement of the end effector 808, the displacement profile ofthe end effector 808, and the end effector 808 contact pressure, suchas, for example, sharpness, clamping force, or other forces applied bythe end effector to a target tissue area.

In one embodiment, the articulable harmonic waveguide 802 may comprise atotal curvature limiter to maximize acoustic transmission and minimizelocal bending stress by minimizing the local curvature (or maximizingthe local bending radius) of the flexible waveguide 806 and minimizingthe total path curvature of the articulable harmonic waveguide 802.

FIG. 57 illustrates one embodiment of an ultrasonic surgical instrument1600 comprising an articulable harmonic waveguide 1602 and a totalcurvature limiter 1628. In the embodiment shown in FIG. 57, the totalcurvature limiter 1628 comprises a stroke limiter 1630 in the handle1622 of the ultrasonic surgical instrument 1600. The stroke limiter 1630may comprise a telescoping, spring-loaded electrical connection 1636placed between a reference mechanical ground 1634 and a shifting controlelement 1632. As the total curvature of the flexible waveguide 1606approaches a predetermined threshold beyond which effective operationcannot be assured, such as the total curvature exceeding one of theabove constraints, the electrical connection 1636 is broken by themovement of the shifting control element 1632 to a predetermineddistance from the mechanical ground 1634. If the electrical connection1636 between the mechanical ground 1634 and the shifting control element1632 is broken, no power is transmitted from an ultrasonic generator,such as, for example, generator 20, to the ultrasonic transducer 1624coupled to the articulable harmonic waveguide 1602.

FIG. 58 illustrates one embodiment of an ultrasonic surgical instrument1700 comprising an articulable harmonic waveguide 1702 and a totalcurvature limiter 1728. The total curvature limiter 1728 comprises atwo-stage electrical connection 1730 with a threshold warning indicator1736. As the total curvature of the flexible waveguide 1706 approaches apredetermined threshold, the continuity of a first electrical connection1732 is broken, causing the threshold warning indicator 1736 to providea threshold warning to the user that the articulable harmonic waveguide1702 is approaching one of the predetermined constraints. In variousembodiments, the threshold warning may comprise a visual warning, anaudible warning, a tactile warning, olfactory warning, or anycombination thereof. If the total curvature increases beyond the warningthreshold, a second electrical connection 1734 is broken, resulting in astoppage of power from the ultrasonic generator to the ultrasonictransducer 1724 of the ultrasonic surgical instrument 1700.

FIG. 59 illustrates one embodiment of an articulable harmonic waveguide1802 comprising a total curvature limiter 1828. The total curvaturelimiter 1828 comprises a resonant frequency shift tracker 1830. Theresonant frequency shift tracker 1830 is coupled to the ultrasonicgenerator (not shown) to provide a feedback signal corresponding to thevibration frequency of the articulable harmonic waveguide 1802. In oneembodiment, the resonant frequency shift tracker 1830 is located at anode. As the resonance of the articulable harmonic waveguide 1802approaches a cut-off frequency due to the change in the radius ofcurvature, the generator may provide a threshold warning to the user. Invarious embodiments, the threshold warning may comprise a visualwarning, an audible warning, a tactile warning, olfactory warning, orany combination thereof. In some embodiments, continued operation beyondthe threshold warning may result in a stoppage of power to theultrasonic transducer 1624.

In one embodiment, illustrated in FIG. 60, the total curvature limiter1928 may comprise a viewing window 1730 located within the handle 1922.The viewing window 1730 may comprise one or more graduations 1934indicative of loss of efficiency due to increase in the radius ofcurvature. A user may view the shifting control elements (not shown)through the view window 1730 in relation to the graduations 1934. Thegraduations 1934 may indicate that the articulable harmonic waveguide1902 is approaching operational limits. The limits may be printed on thehandle, indicating a safe operation zone, a warning zone, and/or ashut-off zone.

In one embodiment, the flexible waveguide 806 may have one or more totalcurvature limiters formed on the flexible waveguide 806. The flexiblewaveguide 806 may comprise one or more of total curvature limiters, suchas, a segmented shaft (such as, for example, a laser etched shaft),articulation joints with fixed ranges of flexure, laterally stiff tubes,and/or limited flexibility tubes. In another embodiment, the articulableharmonic waveguide 802 may be engineered to the intended worst-casecurvature such that the non-compatible local curvature conditions arenot encountered.

In one embodiment, the flexible waveguide 806 may be centered about ananti-node. In the embodiment shown in FIG. 61, the flexible waveguide2006 has a center point 2009 located at an anti-node. By placing thecenter point 2009 at an anti-node, transitions at low (ideally zero)internal stresses and no impact on gain can be obtained by a limitedlength flexible waveguide 2006 centered about an anti-node. In theillustrated embodiment, the junction 2010 between the drive section 2004and the flexible waveguide 2006 and the junction 2012 between theflexible waveguide 2006 and the end effector 2008 are both located at adistance of λ/8 from the center point 2009, where λ is the wavelength ofthe ultrasonic drive signal. Using a thin flexible waveguide 2006 allowsa tighter bend or flex. The bend may be sufficiently tight such that thearticulable harmonic waveguide 2002 may be housed in an articulatingtube set. In one example embodiment, the drive section 2004 may comprisea diameter of 0.170 inches, the flexible waveguide 2006 may comprise aribbon-like section having a thickness of 0.020 inches, and having alength of λ/8.

FIG. 62 illustrates one embodiment of a robotic surgical tool 2100comprising an instrument mounting portion 2122 and an articulableharmonic waveguide 2102. The instrument mounting portion 2122 isconfigured to interface with a robotic surgical system, such as, forexample, the robotic surgical system 500. In this embodiment, thearticulation actuator 2116, the total curvature limiter 2128, and othercontrols for the articulable harmonic waveguide 2102 may be housed inthe instrument mounting portion 2122.

FIG. 63 illustrates one embodiment of a bayonet forceps surgicalinstrument 2300 comprising a shear mechanism 2350. The shear mechanism2350 comprises an articulable harmonic waveguide 2302 and a surgical pad2354. The articulable harmonic waveguide 2302 is similar to thearticulable harmonic waveguide 1302 discussed in FIGS. 52-52B. In theembodiment shown in FIG. 63, the articulable harmonic waveguide 2302comprises a first drive section 2304A, a first flexible waveguide 2306A,a second drive section 2304B, a second flexible waveguide 2306B, anon-flexible waveguide 2312, and an end effector section 2308. The firstand second flexible waveguides 2306A, 2306B both have a flex bias in thesame plane, allowing the articulable harmonic waveguide 2302 to assume abayonet style forceps configuration. A pad tine 2352 runs parallel tothe articulable harmonic waveguide 2302. A surgical pad 2354 is disposedat the distal end of the pad tine 2352. The surgical pad 2354 and theend effector 2308 may be used to treat a tissue section located therebetween.

In one embodiment, the bayonet forceps surgical instrument 2300comprises an ultrasonic transducer for producing a higher than averageultrasonic signal, such as, for example, an 80 kHz signal. The higherfrequency ultrasonic signal allows a smaller ultrasonic transducer to beused. In this embodiment, only the distal most portion of the endeffector 2308 opposite the surgical pad 2354 is used for treatment of atissue section and therefore the shorter wavelength of the highfrequency ultrasonic signal does not cause any feedback issues in thearticulable harmonic waveguide 2302. The bayonet forceps surgicalinstrument 2300 provides a user with a device that closely mimics theoperation of a traditional forceps device. The offset architecture ofthe end effector 2308 also provides excellent visibility to the targettissue site when the device is used.

FIGS. 64A-66B illustrate various embodiments of ultrasonic flexibleshears surgical devices comprising an articulable harmonic waveguide802. FIGS. 64A and 64B illustrate one embodiment of a flexible sheardevice 2400 comprising an articulable harmonic waveguide 2402. The drivesection 2404 is disposed within an outer sheath 2456. First and secondflexible strips 2420A, 2420B are disposed within the outer sheath 2456and connected to the distal end of the outer sheath 2456. The first andsecond flexible strips 2420A, 2420B are connected to an articulationactuator 2421 at their proximal end. The articulation actuator 2421 maybe pivoted causing the first flexible strip 2420A to move proximally andsimultaneously causing the second flexible strip 2420B to move distally.The movement of the first and second flexible strips causes the outersheath 2456 to flex in the direction of the flexible strip that wastranslated proximally, in this case the first flexible strip 2420A. Inone embodiment, the flexible waveguide 2406 of the articulable harmonicwaveguide 2402 may be flexed in unison with the outer sheath 2456.Flexing of the outer sheath 2456 and the articulable harmonic waveguide2402 allows the flexible shear device 2400 to clamp and treat tissuesections that would be difficult or impossible to treat withtraditional, non-flexible shears.

FIGS. 65A and 65B illustrate one embodiment of a flexible shear device2500 with the articulable harmonic waveguide 2402 removed. In theillustrated embodiment, the first and second flexible strips 2420A,2420B are connected to the clamp arm 2554. Movement of the articulationactuator 2516 in the proximal or distal direction causes the clamp arm2554 to pivot from a clamped position, shown in FIG. 65A, to anunclamped position, shown in FIG. 65B. In this embodiment, thearticulation actuator 2516 may be pivoted to cause the outer sheath 2556to articulate at an angle to the longitudinal axis of the outer sheath2556.

FIGS. 66A and 66B illustrate one embodiment of a flexible shear device2600. The flexible shear device 2600 comprises an articulable harmonicwaveguide 2600 disposed within a flexible sheath 2656. The flexiblesheath 2656 may have one or more flex features, such as, for example,flex slots 2657, formed in the flexible sheath 2656 to facilitatearticulation of the flexible sheath 2656 at an angle to the longitudinalaxis of the flexible sheath 2656. A flexible waveguide 2606 may belocated within the flexible sheath 2656 at the location of the one ormore flex slots 2657 to facilitate articulation of flexible sheath 2656and the articulable harmonic waveguide 2602. The flexible sheath 2656may be articulated in a manner similar to that discussed above withrespect to FIGS. 64A-65B.

A processing unit located either at the instrument mounting portion orat the robot controller or arm cart side coupled to the interface may beemployed to control the operation of the various articulable harmonicwaveguides described herein. The processing unit may be responsible forexecuting various software programs such as system programs,applications programs, and/or modules to provide computing andprocessing operations of any of the surgical instruments describedhereinbefore, including the controlling the operation of the variousarticulable harmonic waveguides described herein. A suitable processingunit may be responsible for performing various tasks and datacommunications operations such as transmitting and machine commands anddata information over one or more wired or wireless communicationschannels. In various embodiments, the processing unit may include asingle processor architecture or it may include any suitable processorarchitecture and/or any suitable number of processors in accordance withthe described embodiments. In one embodiment, the processing unit may beimplemented using a single integrated processor.

The processing unit may be implemented as a host central processing unit(CPU) using any suitable processor circuit or logic device (circuit),such as a as a general purpose processor and/or a state machine. Theprocessing unit also may be implemented as a chip multiprocessor (CMP),dedicated processor, embedded processor, media processor, input/output(I/O) processor, co-processor, microprocessor, controller,microcontroller, application specific integrated circuit (ASIC), fieldprogrammable gate array (FPGA), programmable logic device (PLD), orother processing device in accordance with the described embodiments.

In one embodiment, the processing unit may be coupled to a memory and/orstorage component(s) through a bus either at the instrument mountingportion or at the controller/arm cart side. The memory bus may compriseany suitable interface and/or bus architecture for allowing theprocessing unit to access the memory and/or storage component(s).Although the memory and/or storage component(s) may be separate from theprocessing unit, it is worthy to note that in various embodiments someportion or the entire memory and/or storage component(s) may be includedon the same integrated circuit as the processing unit. Alternatively,some portion or the entire memory and/or storage component(s) may bedisposed on an integrated circuit or other medium (e.g., flash memory,hard disk drive) external to the integrated circuit of the processingunit.

The memory and/or storage component(s) represent one or morecomputer-readable media. The memory and/or storage component(s) may beimplemented using any computer-readable media capable of storing datasuch as volatile or non-volatile memory, removable or non-removablememory, erasable or non-erasable memory, writeable or re-writeablememory, and so forth. The memory and/or storage component(s) maycomprise volatile media (e.g., random access memory (RAM)) and/ornonvolatile media (e.g., read only memory (ROM), Flash memory, opticaldisks, magnetic disks and the like). The memory and/or storagecomponent(s) may comprise fixed media (e.g., RAM, ROM, a fixed harddrive, etc.) as well as removable media (e.g., a Flash memory drive, aremovable hard drive, an optical disk, etc.). Examples ofcomputer-readable storage media may include, without limitation, RAM,dynamic RAM (DRAM), Double-Data-Rate DRAM (DDRAM), synchronous DRAM(SDRAM), static RAM (SRAM), read-only memory (ROM), programmable ROM(PROM), erasable programmable ROM (EPROM), electrically erasableprogrammable ROM (EEPROM), flash memory (e.g., NOR or NAND flashmemory), content addressable memory (CAM), polymer memory (e.g.,ferroelectric polymer memory), phase-change memory, ovonic memory,ferroelectric memory, silicon-oxide-nitride-oxide-silicon (SONOS)memory, magnetic or optical cards, or any other type of media suitablefor storing information.

One or more I/O devices allow a user to enter commands and informationto the processing unit, and also allow information to be presented tothe user and/or other components or devices. Examples of input devicesinclude a keyboard, a cursor control device (e.g., a mouse), amicrophone, a scanner and the like. Examples of output devices include adisplay device (e.g., a monitor or projector, speakers, a printer, anetwork card, etc.). The processing unit may be coupled to analphanumeric keypad. The keypad may comprise, for example, a QWERTY keylayout and an integrated number dial pad. A display may be coupled tothe processing unit. The display may comprise any suitable visualinterface for displaying content to a user. In one embodiment, forexample, the display may be implemented by a liquid crystal display(LCD) such as a touch-sensitive color (e.g., 76-bit color) thin-filmtransistor (TFT) LCD screen. The touch-sensitive LCD may be used with astylus and/or a handwriting recognizer program.

The processing unit may be arranged to provide processing or computingresources to the robotically controlled surgical instruments. Forexample, the processing unit may be responsible for executing varioussoftware programs including system programs such as operating system(OS) and application programs. System programs generally may assist inthe running of the robotically controlled surgical instruments and maybe directly responsible for controlling, integrating, and managing theindividual hardware components of the computer system. The OS may beimplemented, for example, as a Microsoft® Windows OS, Symbian OSTM,Embedix OS, Linux OS, Binary Run-time Environment for Wireless (BREW)OS, JavaOS, Android OS, Apple OS or other suitable OS in accordance withthe described embodiments. The computing device may comprise othersystem programs such as device drivers, programming tools, utilityprograms, software libraries, application programming interfaces (APIs),and so forth.

Various embodiments may be described herein in the general context ofcomputer executable instructions, such as software, program modules,and/or engines being executed by a computer. Generally, software,program modules, and/or engines include any software element arranged toperform particular operations or implement particular abstract datatypes. Software, program modules, and/or engines can include routines,programs, objects, components, data structures and the like that performparticular tasks or implement particular abstract data types. Animplementation of the software, program modules, and/or enginescomponents and techniques may be stored on and/or transmitted acrosssome form of computer-readable media. In this regard, computer-readablemedia can be any available medium or media useable to store informationand accessible by a computing device. Some embodiments also may bepracticed in distributed computing environments where operations areperformed by one or more remote processing devices that are linkedthrough a communications network. In a distributed computingenvironment, software, program modules, and/or engines may be located inboth local and remote computer storage media including memory storagedevices.

Although some embodiments may be illustrated and described as comprisingfunctional components, software, engines, and/or modules performingvarious operations, it can be appreciated that such components ormodules may be implemented by one or more hardware components, softwarecomponents, and/or combination thereof. The functional components,software, engines, and/or modules may be implemented, for example, bylogic (e.g., instructions, data, and/or code) to be executed by a logicdevice (e.g., processor). Such logic may be stored internally orexternally to a logic device on one or more types of computer-readablestorage media. In other embodiments, the functional components such assoftware, engines, and/or modules may be implemented by hardwareelements that may include processors, microprocessors, circuits, circuitelements (e.g., transistors, resistors, capacitors, inductors, and soforth), integrated circuits, application specific integrated circuits(ASIC), programmable logic devices (PLD), digital signal processors(DSP), field programmable gate array (FPGA), logic gates, registers,semiconductor device, chips, microchips, chip sets, and so forth.

Examples of software, engines, and/or modules may include softwarecomponents, programs, applications, computer programs, applicationprograms, system programs, machine programs, operating system software,middleware, firmware, software modules, routines, subroutines,functions, methods, procedures, software interfaces, application programinterfaces (API), instruction sets, computing code, computer code, codesegments, computer code segments, words, values, symbols, or anycombination thereof. Determining whether an embodiment is implementedusing hardware elements and/or software elements may vary in accordancewith any number of factors, such as desired computational rate, powerlevels, heat tolerances, processing cycle budget, input data rates,output data rates, memory resources, data bus speeds and other design orperformance constraints.

In some cases, various embodiments may be implemented as an article ofmanufacture. The article of manufacture may include a computer readablestorage medium arranged to store logic, instructions and/or data forperforming various operations of one or more embodiments. In variousembodiments, for example, the article of manufacture may comprise amagnetic disk, optical disk, flash memory or firmware containingcomputer program instructions suitable for execution by a generalpurpose processor or application specific processor. The embodiments,however, are not limited in this context. Applicant also owns thefollowing patent applications that are each incorporated by reference intheir respective entireties:

-   U.S. patent application Ser. No. 13/536,271, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005708, and entitled “Flexible    Drive Member”;-   U.S. patent application Ser. No. 13/536,288, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005718, and entitled    “Multi-Functional Powered Surgical Device with External Dissection    Features”;-   U.S. patent application Ser. No. 13/536,295, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005676, and entitled “Rotary    Actuatable Closure Arrangement for Surgical End Effector”;-   U.S. patent application Ser. No. 13/536,326, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005653, and entitled “Surgical    End Effectors Having Angled Tissue-Contacting Surfaces”;-   U.S. patent application Ser. No. 13/536,303, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005661, and entitled    “Interchangeable End Effector Coupling Arrangement”;-   U.S. patent application Ser. No. 13/536,393, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005640, and entitled “Surgical    End Effector Jaw and Electrode Configurations”;-   U.S. patent application Ser. No. 13/536,362, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005662, and entitled    “Multi-Axis Articulating and Rotating Surgical Tools”; and-   U.S. patent application Ser. No. 13/536,417, filed on Jun. 28, 2012,    now U.S. Patent Publication No. 2014/0005680, and entitled    “Electrode Connections for Rotary Driven Surgical Tools”.

It will be appreciated that the terms “proximal” and “distal” are usedthroughout the specification with reference to a clinician manipulatingone end of an instrument used to treat a patient. The term “proximal”refers to the portion of the instrument closest to the clinician and theterm “distal” refers to the portion located furthest from the clinician.It will further be appreciated that for conciseness and clarity, spatialterms such as “vertical,” “horizontal,” “up,” or “down” may be usedherein with respect to the illustrated embodiments. However, surgicalinstruments may be used in many orientations and positions, and theseterms are not intended to be limiting or absolute.

Various embodiments of surgical instruments and robotic surgical systemsare described herein. It will be understood by those skilled in the artthat the various embodiments described herein may be used with thedescribed surgical instruments and robotic surgical systems. Thedescriptions are provided for example only, and those skilled in the artwill understand that the disclosed embodiments are not limited to onlythe devices disclosed herein, but may be used with any compatiblesurgical instrument or robotic surgical system.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one example embodiment,” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment is included in at least one example embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one example embodiment,” or “in an embodiment” inplaces throughout the specification are not necessarily all referring tothe same embodiment. Furthermore, the particular features, structures,or characteristics illustrated or described in connection with oneexample embodiment may be combined, in whole or in part, with features,structures, or characteristics of one or more other embodiments withoutlimitation.

While various embodiments herein have been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art. For example, each of thedisclosed embodiments may be employed in endoscopic procedures,laparoscopic procedures, as well as open procedures, without limitationsto its intended use.

It is to be understood that at least some of the figures anddescriptions herein have been simplified to illustrate elements that arerelevant for a clear understanding of the disclosure, while eliminating,for purposes of clarity, other elements. Those of ordinary skill in theart will recognize, however, that these and other elements may bedesirable. However, because such elements are well known in the art, andbecause they do not facilitate a better understanding of the disclosure,a discussion of such elements is not provided herein.

While several embodiments have been described, it should be apparent,however, that various modifications, alterations and adaptations tothose embodiments may occur to persons skilled in the art with theattainment of some or all of the advantages of the disclosure. Forexample, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Thisapplication is therefore intended to cover all such modifications,alterations and adaptations without departing from the scope and spiritof the disclosure as defined by the appended claims.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A surgical instrument, comprising: an articulablewaveguide configured to transmit ultrasonic energy therealong, thearticulable waveguide comprising: a proximal drive section configured tocouple to an ultrasonic transducer; an end effector positioned at adistal portion of the articulable waveguide; and a first flexiblesection comprising a flex bias, the first flexible section positionedbetween the proximal drive section and the end effector; a first tineextending longitudinally relative to the articulable waveguide.
 2. Thesurgical instrument of claim 1, wherein the articulable waveguidefurther comprises a non-flexible section positioned between the firstflexible section and the end effector.
 3. The surgical instrument ofclaim 2, wherein the articulable waveguide further comprises a secondflexible section comprising a flex bias, the second flexible sectionpositioned between the non-flexible section and the end effector,wherein the flex bias portions of the first and second flexible sectionsare disposed along the same plane.
 4. The surgical instrument of claim1, further comprising a pad positioned at a distal end of the firsttine, wherein the pad and the end effector are configured to receivetissue therebetween and coact to treat the tissue positionedtherebetween.
 5. The surgical instrument of claim 4, further comprisinga second tine that extends longitudinally, wherein the first tine or theend effector are positioned distal to the second tine to provide anoffset configuration.
 6. The surgical instrument of claim 5, wherein thepad on the first tine and the end effector are positioned distalrelative to the second tine.
 7. The surgical instrument of claim 1,further comprising an ultrasonic transducer acoustically coupled to theproximal drive section.
 8. The surgical instrument of claim 7, whereinthe ultrasonic transducer is configured to produce mechanical vibrationsat a frequency range of about 60 kHz to 120 kHz.
 9. A surgicalinstrument, comprising: an articulable waveguide configured to transmitultrasonic energy therealong, the articulable waveguide comprising: afirst drive section configured to couple to an ultrasonic transducer; afirst flexible section comprising a first flex bias; a non-flexiblesection; and an end effector positioned at a distal portion of thearticulable waveguide; and a first tine comprising a distal end, whereinthe first tine comprises a pad disposed at the distal end of the firsttine.
 10. The surgical instrument of claim 9, wherein the articulablewaveguide further comprises: a second drive section; and a secondflexible section comprising a second flex bias.
 11. The surgicalinstrument of claim 10, wherein the second drive section is positioneddistal with respect to the first drive section, wherein the secondflexible section is positioned distal with respect to the first flexiblesection, and wherein the non-flexible section is positioned distal withrespect to the second drive section and the second flexible section. 12.The surgical instrument of claim 10, wherein the first flex bias and thesecond flex bias are disposed along the same plane.
 13. The surgicalinstrument of claim 11, wherein the first flex bias and the second flexbias are disposed along the same plane.
 14. The surgical instrument ofclaim 9, wherein the pad and the end effector are configured to receivetissue therebetween and coact to treat the tissue positionedtherebetween.
 15. The surgical instrument of claim 14, furthercomprising a second tine that extends longitudinally, wherein the firsttine or the end effector are positioned distal to the second tine toprovide an offset configuration.
 16. The surgical instrument of claim 9,further comprising an ultrasonic transducer acoustically coupled to thefirst drive section.
 17. A surgical instrument configured to beacoustically coupled to an ultrasonic transducer, the surgicalinstrument comprising: an articulable waveguide configured to transmitultrasonic energy therealong, the articulable waveguide comprising: aproximal drive section; a proximal flexible section comprising aproximal flex bias; a non-flexible section; and an end effectorpositioned at a distal portion of the articulable waveguide; and a tinecomprising a distal end, wherein the tine comprises a pad disposed atthe distal end.
 18. The surgical instrument of claim 17, wherein thearticulable waveguide further comprises: a distal drive section; and adistal flexible section comprising a distal flex bias.
 19. The surgicalinstrument of claim 18, wherein the proximal flex bias and the distalflex bias are disposed along the same plane.
 20. The surgical instrumentof claim 17, wherein the tine is positioned distal with respect to theend effector.
 21. The surgical instrument of claim 17, wherein the padand the end effector are configured to receive tissue therebetween andcoact to treat the tissue positioned therebetween.